Pacifica Royale Assisted Living Community

Allegation investigated: Staff did not ensure the elevator was not in disrepair resulting in residents being isolated

Licensing Program Analyst (LPA) Fred Arias conducted an unannounced complaint visit to finalize an investigation into the above allegation. LPA was greeted and granted entry into the facility and explained the reason for the visit. It was alleged staff did not ensure the elevator was not in disrepair resulting in residents being isolated. LPA conducted interviews with staff and residents. LPA reviewed records obtain. The investigation determined as follows: Regarding the allegation staff did not ensure the elevator was not in disrepair resulting in residents being isolated, it was reported the elevator was broken for many months without attempting to repair and residents could not access services like food and activities. LPA observed elevator in good working order. LPA observed the elevator permit to operate issued by the California Department of Industrial Relations date August 11, 2025 valid for one year located inside the elevator. LPA observed two evacuation chairs set up in the two stairways for the facility. Unsubstantiated In addition, the facility recently installed electric power chair lifts in one of the stairways to assist non-ambulatory residents to move from floor to floor. During an annual conducted on April 9, 2026 by the Department, the evacuations chairs were observed by the LPA and LPA observed the elevator in working order. Interviews with five out of five residents confirmed the elevator did not work from one to five days in March 2026. The five residents stated during this time, meals were delivered to their rooms and were assisted with activities of daily living (ADLs). The five residents could not recall another time when the elevator was non-operational longer than five days in the past. Four out of the five residents stated medications were provided in their rooms during this time. The remaining resident stated they did not require the use of medications. Interviews with eight out of eight staff stated the elevator was not operational for approximately three to five days early March 2026. The eight staff added meal service, medication administration, and other ADLs were provided to the residents while the facility worked on repairing the elevator. Eight out of eight staff denied the elevator was in disrepair longer than five days in the past. Record review revealed the facility had a maintenance contract in place effective March 1, 2026 to May 31, 2026 with Amtech Elevator Services. Administrator Edward Maslobodsky provided check stubs for payments made to Ametech Elevator Services for repairs made on October 9, 2025, November 3, 2025, and March 4, 2026. The facility also paid Delta Elevator on April 7, 2026 for an additional repair since the incident occurred. Although the elevator was non-operational for some days in March 2026, the facility took action to make repairs to the elevator and provided appropriate services to the residents during this time. Based on interviews, records observed, and LPA observations, the allegation staff did not ensure the elevator was not in disrepair resulting in residents being isolated therefore is deemed unsubstantiated meaning that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. An exit interview was conducted and a copy of the report was left with the facility representative. The remaining three staff did not add anything relevant to the allegation. Based on interviews and observations, LPA is unable to corroborate the allegation. Therefore, the allegation is deemed to be UNFOUNDED, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. An exit interview was conducted and a copy of the report was left with the facility.the state’s words, verbatim · CDSS document, Apr 22, 2026 · control 22-AS-20260415121540

Type of visit: Required - 1 Year

On this day Licensing Program Analyst (LPA) Fred Arias made an unannounced visit to conduct a required annual visit. LPA was greeted and granted entry into the facility by staff and explained the reason for the visit. Facility is a three level structure and is licensed for 132 residents of which 66 may be non-ambulatory, three may be on hospice, and none may be bedridden. Administrator (AD) Edward Maslobodsky arrived shortly to help conduct the visit. AD has a valid certificate that expires on 5/15/2027. LPA along with staff toured the facility at 9:10 AM. LPA toured the physical plant, checked food service, and facility documentation. LPA toured a total of six random resident bedrooms of which, resident bedrooms had the required furniture, bed linens and closet/drawer space to accommodate each resident comfortably. Resident bathrooms were checked. Water faucets worked properly, grab bars were secure and showers were free of mold/mildew. Water temperature measured between 110.8 degrees F and 113.7 degrees F in all bathrooms checked. Resident bath towels, toiletries and personal hygiene supplies were adequately stocked. Common areas were clean and clear of hazards. LPA toured the kitchen. Perishable and non-perishable food supply was checked and adequately stocked at time of visit. Kitchen appliances were operational during today's visit. Fire alarm system was last serviced on 4/24/2025. Fire extinguishers observed were fully charged. LPA reviewed the infection control and emergency disaster plans and plans are complete and thorough. Facility conducts monthly emergency drills with the last drill conducted on 3/14/2026. LPA observed evacuation chairs, one for each stair way. Outside grounds were toured. There is shaded outdoor seating for residents. Continued on LIC809-C dated 4/9/2026 First aid kit contained all required items including tweezers, scissors and thermometer. LPA observed residents playing bingo and watching TV. Exit gates are unlocked and operational. LPA observed the emergency food and water supply. LPA reviewed seven resident files and six staff files. All resident files contained required documentation including admission agreements, physician reports, and resident appraisals. Staff files reviewed contained required documentation including required annual training, medical assessment/ TB, criminal record clearance and proof of CPR training. LPA reviewed medication storage and administration. Medications are stored in medication carts and in the medication room. Based on the observations made during today’s visit, no deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. This report was discussed with the facility representative and a copy was provided.the state’s words, verbatim · CDSS document, Apr 9, 2026

Allegation investigated: Facility staff did not meet resident's dental hygiene needs.

Licensing Program Analyst (LPA) Fred Arias conducted an unannounced complaint visit to continue an investigation into the above allegation. LPA was greeted and granted entry into the facility and explained the reason for the visit. An initial investigation visit was conducted on August 23, 2021 by LPA Lydia Martinez. During the visit, LPA Martinez obtained documents related to the complaint and interviewed staff. It was alleged faciity staff did not meet resident's dental hygiene needs. During the investigation, LPA Arias conducted interviews with residents in care and staff. LPA reviewed records obtained. The investigation determined as follows: Regarding the allegation facility staff did not meet resident's dental hygiene needs, it was reported during an emergency admission at a hospital in 2021, resident 1 (R1)'s dentures were found to be dirty and black with old corroded denture adhesive. Continued on LIC9099-C dated 07/01/2025 Unsubstantiated LPA interviews with four out of four residents stated they had no issues with assistance with getting dental or medical appointments if needed. One out four residents interviewed wears dentures and stated they clean their own dentures but will notify the staff if cleaning supplies are needed. LPA interviews with two out of two staff stated the facility arranges medical and dental appointments along with transportation to those appointments. Two out of two staff stated R1 was cognitive and was able to make their own decisions. In addition, two out of two staff stated R1 was able to eat and brush their teeth on their own. One out of two staff also added they were a primary caregiver for R1 and R1's dentures were observed to be in good condition while R1 lived at the facility. LPA reviewed R1's records available. Therefore based on client interviews, staff interviews, records reviewed, and LPA observations, the allegation of facility staff did not meet resident's dental hygiene needs is therefore deemed unsubstantiated meaning that although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violations occurred.the state’s words, verbatim · CDSS document, Jul 1, 2025 · control 22-AS-20210823130330

Allegation investigated: Staff bathed a resident with cold water causing the resident pain. Staff made inappropriate comments to a resident. Staff did not treat a resident with dignity and respect.

Licensing Program Analyst (LPA) Fred Arias conducted an unannounced complaint visit to continue an investigation into the above allegations. LPA was greeted and granted entry into the facility and explained the reason for the visit. An initial investigation visit was conducted on March 14, 2024 by LPA Celine Rodriguez. During the visit, LPA Rodriguez toured the physical plant of the facility, conducted interviews, and requested copies of pertinent records reviewed. It was alleged staff bathed a resident with cold water causing the resident pain, staff made inappropriate comments to a resident and staff did not treat a resident with dignity and respect. During the investigation, LPA Arias conducted interviews with residents in care and staff. LPA Arias reviewed records obtained. The investigation determined as follows: Regarding the allegation staff bathed a resident with cold water causing the resident pain, it was reported staff used cold water while bathing resident that caused pain in their legs. Continued on LIC9099-C dated 07/01/2025 Unsubstantiated LPA interviews with four out of five residents stated they had no issues with assistance with showers from staff. Four out of five residents stated staff always wait until the water is warm enough before placing resident in the shower. One out of five residents stated they were once placed in the shower first and then the water was turned on with the shower head pointing to the side, causing cold water to splash from against the wall onto their body causing pain. LPA interviews with three out of three staff stated it is standard to turn on the water and adjust the temperature before placing the resident in the shower but sometimes the procedure varies based on the preference and needs of the resident. Three out of three staff stated showers are never given with cold water. One out of three staff stated water temperatures can vary at times depending on water usage in nearby bathrooms. Regarding the allegation staff made inappropriate comments to a resident, it was reported staff called a resident a "baby" and was told "don't be a baby" during a shower. LPA interviews with four out of five residents stated staff have never made inappropriate comments towards them. One out of four residents stated they were told "don't be a baby" during a shower. LPA interviews with three out of three staff stated they have never made inappropriate comments to residents. One out of three staff added any complaints about inappropriate comments would be addressed immediately. Regarding the allegation staff did not treat a resident with dignity and respect, it was reported a staff member is dismissive and exhibits gossiping behaviors about a resident. LPA interviews with five out of five residents stated they are unaware of any dismissive or gossiping behaviors by staff. LPA interviews with three out of three staff denied any dismissive or gossiping behaviors. LPA record review for two staff present revealed they have received mandatory reporting requirements training. Therefore based on client interviews, staff interviews, records observed, and LPA observations, the allegations of staff bathed a resident with cold water causing the resident pain, staff made inappropriate comments to a resident, and staff did not treat a resident with dignity and respect are therefore deemed unsubstantiated meaning that although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violations occurred. An exit interview was conducted and a copy of the report was left with the facility representative.the state’s words, verbatim · CDSS document, Jul 1, 2025 · control 22-AS-20240305134345

Type of visit: Required - 1 Year

On this day Licensing Program Analyst (LPA) Fred Arias made an unannounced visit to conduct a required annual visit. LPA was greeted and granted entry into the facility by staff and explained the reason for the visit. Facility is a three level structure and is licensed for 132 residents, of which 3 may be on hospice and 0 may be bedridden. Administrator (AD) Edward Maslobodsky arrived shortly to help conduct the visit. AD has a valid certificate that expires on 5/15/2025. LPA along with staff toured the facility at 9:00 AM. LPA toured the physical plant, checked food service, and facility documentation. LPA toured a total of 8 random resident bedrooms of which, resident bedrooms had the required furniture, bed linens and closet/drawer space to accommodate each resident comfortably. Resident bathrooms were checked. Water faucets worked properly, grab bars were secure and showers were free of mold/mildew. Water temperature measured between 116.2 degrees F and 119.3 degrees F in all bathrooms. Resident bath towels, toiletries and personal hygiene supplies were adequately stocked. Common areas were clean and clear of hazards. At 11:10am, LPA observed medication pills in a clear plastic cup located in the bathroom shelf for Resident 2 (R2). LPA toured the kitchen, perishable and non-perishable food supply was checked and adequately stocked at time of visit. Kitchen appliances were operational during today's visit. Fire deterrent system was last serviced on 4/15/2025. Fire extinguishers observed were fully charged. LPA reviewed the infection control and emergency disaster plans and plans are complete and thorough. Facility conducts monthly emergency drills with the last drill conducted on 3/25/2025. LPA observed evacuation chairs, one for each stair way. Outside grounds were toured. There is shaded outdoor seating for residents. Continued on LIC809C dated 4/17/2025 First aid kit contained all required items including tweezers, scissors and thermometer. Facility conducts activities in the form of exercise, puzzles, and bingo. Exit gates are unlocked and operational. LPA observed the emergency food and water supply. LPA reviewed eight resident files and six staff files. All resident files contained required documentation including admission agreements, physician reports, and resident appraisals. Staff files reviewed contained required documentation including required annual training, medical assessment/ TB, criminal record clearance and proof of CPR training. LPA reviewed medication storage and administration. Medications are stored in medication carts and in the medication room. Based on the observations made during today’s visit, a deficiency is being cited per Title 22 Division 6 of the California Code of Regulations. This report was discussed with the facility representative and a copy was provided along with appeal rights.the state’s words, verbatim · CDSS document, Apr 17, 2025

The state marks this report as 7 pages; the online copy we transcribed has 4. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Celine De Perio conducted an unannounced required annual inspection. LPA De Perio was greeted by staff on duty, who notified facility administrator (AD) Edward Maslobodsky about visit. The PUB475 "See Something, Say Something" poster was observed to be posted at the entrance of the facility. LPA observed the Administrator's Certificate for Edward Maslobodsky, which expires on 5/15/2025, and is posted at the front entrance of the facility. LPA De Perio toured the interior and exterior portions of the facility with AD Maslobodsky. Facility is a three level structure and is licensed for 132 residents, of which 3 may be on hospice and 0 may be bedridden. LPA De Perio toured a total of 9 random resident bedrooms of which, bedrooms observed were provided with furniture in good repair, clean linens, adequate storage space, and kept free of tripping hazards. Smoke and carbon monoxide detector and auditory exit alarms were tested and operational. Most recent fire inspection took place on 3/6/2024. The restrooms were observed to be in good repair, toilets were operational, and grab bars and non-skid floor mats were provided. Water temperature in restrooms were measured at 106.4 degrees Fahrenheit. LPA De Perio also tested pull cords in random resident rooms, and observed for it to be operational. Facility met the minimum two-day perishable and seven-day non-perishable food supplies. Sharp items and knives were locked and inaccessible to residents in care. Fire extinguishers were charged, mounted and located in multiple areas of the facility. LPA De Perio tested delayed egress doors and observed for it to be operational. LPA De Perio also observed evacuation chairs in stairwells. For the exterior portion, LPA De Perio observed patio furniture under shading, and the grounds were free of any hazards. LPA De Perio observed the emergency disaster and evacuation plan, which is posted at at the front desk of the facility. Facility had back-up emergency food and water supply, located in the kitchen and in multiple storage areas around the kitchen. LPA De Perio observed that First Aid Kit had all the required components. Medications were locked, and made in accessible to residents in care, and is located in the medication room. Toxins were also observed to be locked and inaccessible to residents. For this visit, no citations were issued. LPA De Perio conducted an exit interview with AD Maslobodsky. A copy of this report was provided and explained to the facility.the state’s words, verbatim · CDSS document, Apr 13, 2024

Type of visit: Case Management - Incident

Licensing Program Analyst (LPA) Celine De Perio conducted an unannounced case management to the facility to follow up on a incident report received dated for 4/4/24. LPA explained reason for visit and was greeted by staff on duty (S1) Ludmila Pogosyan. Facility administrator (AD) Edward Maslobodsky was unable to be present during time of visit. Per resident (R1) physician report, R1 does not have mild cognitive impairment/dementia, is able to leave the facility unassisted, and is responsible for self. It was observed that the facility reported the incident to the department, police and R1's family. For this visit, no health and safety concerns were noted. No citations issued. A copy of this report was provided and explained to S1.the state’s words, verbatim · CDSS document, Apr 10, 2024

Allegation investigated: Facility staff threatened a resident after the resident refused to take a prescribed medication

Licensing Program Analyst (LPA) Kimberly Lyman conducted an unannounced complaint visit to initiate an investigation into the above allegation. LPA was greeted and granted entry into the facility and explained the reason for the visit. Administrator Edward Maslobodsky arrived during the visit. During the course of the investigation, LPA toured the facility, interviewed staff and resident as well as reviewed and obtained pertinent documentation such as physician report. Regarding the allegation that facility staff threatened a resident after the resident refused to take a prescribed medication, the investigation revealed the following: Resident 1 (R1) is prescribed Risperidone 1 MG by mouth twice daily for Schizophrenia. Resident has started refusing that medication along with other prescribed medication. Resident states refusing medication as it was prescribed by a primary care physician and not the resident's psychiatrist as well as side effects from the medication. Facility arranged for physician to see the resident on 01/19/2024 regarding medication changes and refusals. Physician notes indicate the resident's desire to discontinue the medication along with physician concern over discontinuing the medication and the resident's current psychiatric state. CONTINUED ON LIC 9099C DATED 01/23/2024 Unsubstantiated Two out of two staff deny the resident was threatened in any way or coerced into taking medication. Facility staff indicate assisting resident with the process to discontinue medications. Based on interviews conducted and record review, LPA is unable to corroborate the allegation. Therefore, the allegation is deemed unsubstantiated, meaning that although the allegation may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violation occurred. Exit interview conducted and a copy of this report was provided.the state’s words, verbatim · CDSS document, Jan 23, 2024 · control 22-AS-20240119113253