Pacific Pines

Allegation investigated: Resident in care was diagnosed with severe dehydration.

Licensing Program Analysts (LPAs) Sarina Ramirez and Andrew Martinez conducted an unannounced visit to deliver findings on the allegations mentioned. LPAs met with House Manager Annaliza Lazo and explained the purpose of the visit. The Department's investigation involved interviews and records review. It is alleged a resident in care was diagnosed with severe dehydration. The medical records confirm that Resident #1 (R1) was dehydrated but also show consistent communication among the facility administrator, R1’s family, and hospital staff. Over the span of two years of R1’s stay at the facility, both family members and staff report R1 has consistently received good care, including adequate food and hydration. A family member responsible for overseeing R1’s medical needs stated that relatives visit frequently, often weekly or daily to ensure R1’s well being and affirmed that staff provide attentive care. Medical professionals did not attribute her dehydration to facility neglect. Based on the available information, there is insufficient evidence to conclude that R1’s hospitalization for dehydration resulted from neglect or lack of supervision. The allegation is therefore deemed unsubstantiated. Unsubstantiated Based on lack of evidence, Departments observations, and interviews, the allegation above is Unfounded. A finding that the complaint is unfounded means that the allegation is false, could not have happened, and/or is without a reasonable basis. An exit interview was conducted with House Manager Annaliza Lazo, and a copy of this report was provided at the conclusion of the visit. Based on Departments observations, staff and resident interviews, and relevant documentation, the allegation is determined to be Unsubstantiated. An Unsubstantiated finding means that although the allegations may be valid or could have occurred, there is insufficient evidence to support that the alleged violations did or did not happen. An exit interview was conducted with House Manager Annaliza Lazo, and a copy of this report was provided at the conclusion of the visit.the state’s words, verbatim · CDSS document, Feb 5, 2026 · control 56-AS-20250313143700

Allegation investigated: Staff are not fingerprint or background cleared

Licensing Program Analysts (LPA) E. Conchas conducted an unannounced complaint visit to deliver findings. During today’s visit LPA met with Administrator, Iren Creighton, and discussed the purpose of today's visit. The investigation consisted of the following: LPA interviewed facility staff and resident, and gathered pertinent information. Regarding the allegation, Staff are not fingerprint or back background cleared; Interviews and file review reveal staff 10 has worked at the facility and did not have a file available with a fiingerprint/ background at facility. Continue LIC 9099-C, LIC 9099-D. Substantiated Based on the evidence found during the investigation, the allegations Administrator qualifications, Staff mishandled resident, and Insufficient staff available are deemed UNSUBSTANTIATED. A finding that the complaints are UNSUBSTANTIATED means although the allegation may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur. During today’s visit, no deficiencies were cited per Title 22, Division 6, of the California Code of Regulations. Based on the Department’s investigation, the above allegations are Substantiated. A finding that the complaint is Substantiated means that the allegation is valid because the preponderance of the evidence standard has been met. An exit interview was conducted where this report was discussed and a copy with appeal rights was provided to Administrator, Iren Creighton at the conclusion of the visit.the state’s words, verbatim · CDSS document, Jan 12, 2026 · control 56-AS-20251013161721

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87411(g)(1) · Plan of correction due date: Jan 13, 2026

(g) Prior to employment or initial presence in the facility, all employees...:(1)Obtain a California clearance or a criminal record exemption as required by law or Department regulations or:this requirement is not met as evidenced by: The Licensee did not comply with the section cited above by allowing Staff 10 (S10) to work at facility with out clearance , which poses an immediate health, safety and personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Jan 12, 2026

Plan of correction: Administrator stated staff 10 no longer works at facility. Administrator will ensure to have clearance completed and on file prior to working at facility

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 Amanda Santos, and discussed the purpose of the visit. The facility is a Residential Care Facility for the Elderly (RCFE) with a license capacity of (14), a current census of (12). 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 inspected by RSD alarms on 4/24/24, working laundry equipment, and telephone service. Resident’s showers, toilets, and hand washing areas were operating properly. The hot water temperature in three (3) resident bathrooms measured between 106.2 and 114 degrees F. Eight (8) 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 sketch, emergency disaster plan and telephone numbers, monthly menu, personal and resident rights, staff schedule, monthly activities, 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. Five (5) 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 provided to Administrator Amanda Santos.the state’s words, verbatim · CDSS document, Mar 18, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Paola Guerrero made an unannounced visit to the facility. The purpose of the visit was to conduct a required comprehensive annual inspection. LPA met with Facility Administrator Amanda Santos and was granted entry to the facility. At the time of the visit there was four (4) staff present, and twelve (12) residents present. The facility is a eight (8) bedroom, seven (7), bathroom home, with a kitchen/dining area, living room, with open driveway. The facility is a Residential Care Facility for Elderly (RCFE) Licensed capacity is (14) current census (12). LPA was accompanied by Facility Administrator, to conduct a general overall inspection, which included, but was not limited to, the following: Physical Plant: The facility is operating in the capacity approved by Community Care Licensing (CCL). There are no obstructions to indoor and outdoor passageways. The facility is maintained at a comfortable temperature. LPA inspected resident’s bedrooms; they are equipped with required furniture such as: mattresses, nightstands, storage space, and sufficient lighting; bathrooms were clean, and appliances were operating appropriately. LPA observed sufficient furniture and lighting throughout the facility. LPA The facility is equipped with operating smoke detectors and carbon monoxide alarms. Posters such as personal rights, the CCL complaint poster, and the disaster plan were posted in a common area. Cleaning supplies, toxins, sharps, and other dangerous items were kept inaccessible to residents in care. There was a designated storage space for resident/staff files. Medications are kept inside Med-Room on second floor. inaccessible to residents in care. Overall, the facility is clean, in good repair, and operating in safe conditions for residents in care. Food Service: Non-perishable and perishable food supply is sufficient for number of residents in care. Care & Supervision: Facility has sufficient care staff for coverage 24 hours a day, 7 days a week. All staff members working in the facility have criminal record clearance through the department. Record Review: LPA reviewed four (4) resident files for admission agreements, updated physician reports, and needs and services plans. LPA also reviewed four (4) staff files for First Aid/CPR certification, criminal record clearance, training, and health screenings. Medications were audited at random and appeared to be dispensed appropriately by staff members. Based on the observations made during today’s visit, no deficiencies were cited per Title 22, Division 6, of the California Code of Regulations. An exit interview was conducted, and this report (LIC809) was discussed and provided to Facility Administrator Amanda Santos.the state’s words, verbatim · CDSS document, Apr 8, 2024