Pacific Pines

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Sarina Ramirez made an unannounced visit to the facility to conduct a required annual inspection. LPA met with Administrator Ishmael Siapco, and discussed the purpose of the visit. The facility is a Residential Care Facility for the Elderly (RCFE) with a license capacity of (10), a current census of (10). LPA conducted an overall inspection of the facility, which included, but was not limited to, the following: Physical Plant/Environment: Indoor and outdoor passageways are free of obstruction. The facility does not have a swimming pool or similar bodies of water. The facility has sufficient lighting and is maintained at a comfortable temperature. The facility has sufficient indoor and outdoor space for resident activities. Activities consist of puzzles, sing a-longs, and dominoes. The facility is equipped with operating smoke detectors/carbon monoxide alarms, working laundry equipment, and telephone service. Resident’s showers, toilets, and hand washing areas were operating properly. The hot water temperature in two (2) resident bathrooms measured between 110.4 and 112.2 degrees F. Four (4) resident’s bedrooms had beds, bed linen, chairs, dresser, storage space and sufficient lighting. The facility has sufficient linens, towels, and personal hygiene items for residents. The facility has posted in a common area, facility license, facility sketch, emergency telephone numbers, personal and resident rights, menu, CCLD complaint poster, and Ombudsman poster. Continuation on LIC – 809C: Food Service: Facility kitchen and dining area are maintained clean. The facility has sufficient non-perishable and perishable food supply for residents in care. Sharps and chemicals were not kept locked and inaccessible to residents in care, deficiency issued. Care & Supervision: Facility has 24-hour/7days a week care staff. One (1) Facility staff had an expired CPR certificate, technical violation issued. Medical Related Services: Resident’s medications are labeled and centrally stored in a locked cabinet, one (1) resident's medication was audited and random with discrepancies, deficiency issued. Record Review: Four (4) Staff files reviewed were observed to be complete, other than Staff #1 (S1) expired CPR certificate. Four (4) Resident files reviewed were observed to be incomplete, deficiency issued. Facility did not have an emergency disaster plan, deficiency issued. Facility has not conducted a disaster drill since December 2024, deficiency issued. Based on observations and record review technical violations and deficiencies were cited per Title 22, Division 6, of the California Code of Regulations. An exit interview was conducted, and this report (LIC 809, 809C, 809D, 9102) and appeal right were discussed and a copy was provided to Administrator Ishmael Siapco.the state’s words, verbatim · CDSS document, Jan 29, 2026

The state marks this report as 11 pages; the online copy we transcribed has 6. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Sarina Ramirez made an unannounced visit to the facility to conduct a required annual inspection. LPA met with Administrator Nancy Thrane, and discussed the purpose of the visit. The facility is a Residential Care Facility for the Elderly (RCFE) with a license capacity of (10), a current census of (10). LPA conducted an overall inspection of the facility, which included, but was not limited to, the following: Physical Plant/Environment: Indoor and outdoor passageways are free of obstruction. The facility does not have a swimming pool or similar bodies of water. The facility has sufficient lighting and is maintained at a comfortable temperature. The facility has sufficient indoor and outdoor space for resident activities. The facility is equipped with operating smoke detectors/carbon monoxide alarms last checked by RSD alarms on 12/02/24, working laundry equipment, and telephone service. Resident’s showers, toilets, and hand washing areas were operating properly. The hot water temperature in two (2) resident bathrooms measured between 106 and 109 degrees F. Five (5) resident’s bedrooms had beds, bed linen, chairs, dresser, storage space and sufficient lighting. The facility has sufficient linens, towels, and personal hygiene items for residents. The facility has posted in a common area, facility license, facility sketch, emergency telephone numbers, personal rights, activities calendar, menu, CCLD complaint poster, and Ombudsman poster. Food Service: Facility kitchen and dining area are maintained clean. The facility has sufficient non-perishable and perishable food supply for residents in care. Sharps and chemicals were kept locked and inaccessible to residents in care. Continuation on LIC – 809C: Care & Supervision: Facility has 24-hour/7days a week care staff. Facility staff have current CPR/first aid training. Medical Related Services: Resident’s medications are labeled and centrally stored in a locked cabinet. Record Review: Four (4) Staff files reviewed were observed to be complete. Four (4) Resident files reviewed were observed to be complete. Based on observations and record review no deficiencies were cited per Title 22, Division 6, of the California Code of Regulations. An exit interview was conducted, and this report was discussed and a copy was provided to Administrator Nancy Thrane.the state’s words, verbatim · CDSS document, Jan 23, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Magda Malcore made an unannounced visit to the facility to conduct a required annual inspection. LPA met with Nancy Thrane, Administrator, and discussed the purpose of the visit. The facility is a Residential Care Facility for the Elderly (RCFE) with a license capacity of (10) and a current census of (9) residents in care. The facility has a hospice waiver for (2) residents. LPA conducted an overall inspection of the facility, which included, but was not limited to, the following: Physical Plant: Indoor and outdoor passageways are free of obstruction. The facility has no bodies of water accessible to residents in care. Outdoor shaded area is sufficient for resident activities; however the facility does not have an entirely enclosed outdoor leisure space and is currently providing care for persons with Dementia. Deficiency cited. The facility has sufficient lighting and is maintained at a comfortable temperature. Resident’s bathrooms were operating in safe and sanitary conditions. The hot water temperature in residents' bathrooms measured 106 degrees F. Resident’s bedrooms have sufficient lighting and furniture in good repair. Facility has carbon monoxide detectors and telephone service. The facility has sufficient linen, towels, and personal hygiene items for residents. The facility has posted in a common area, Community Care Licensing complaint poster, Ombudsman poster, theft and loss policy, "oxygen in use" signs, and emergency telephone numbers. Care & Supervision: Facility has 24-hour care staff. Staff working have criminal record clearances or exemptions through the Department. Food Service: Facility has sufficient non-perishable and perishable food supply for residents in care. The refrigerator and freezer are operating in a healthful manner. Sharps, pesticides and other cleaning solutions were kept locked and stored away from food areas. Record Review: Review of (4) staff files reveal, the facility did not maintain record of staff #1 (S1) and staff #2 (S2) required job training on file. Deficiency cited. (4) resident files reviewed were observed to be complete. The last fire safety drill was conducted on 12/13/23. Administrator’s certification expires on 2/9/2024. Facility's liability insurance expires on 4/22/24. Medical Related Services: All medication is centrally stored and kept locked in medication room. Based on observations and record review, deficiencies are being cited per Title 22, Division 6 of The California Code of Regulations. An exit interview was conducted where the licensing reports were discussed and copies with Appeal Rights were provided to the Administrator at the conclusion of the visit.the state’s words, verbatim · CDSS document, Jan 29, 2024