PACIFICA SENIOR LIVING SOUTH COAST

Official classification

Type A

Official code

87465(h)(2)

Regulation authority

CCR

What the official deficiency says

87465 Incidental Medical and Dental Care: (h) The following requirements shall apply to medications which are centrally stored: (2) Centrally stored medicines shall be kept in a safe and locked place that is not accessible to persons other than employees... This requirement is not evidenced by: Based on interviews and records reviewed, the Licensee did not ensure that R1's medications were stored in a safe and locked place, due to R1 not being able to store her own medication per her Physician's Report. This poses an immediate health and safety risk to persons in care.

Official plan of correction

The Executive Director stated that she will centrally store R1's medication. The Executive Director stated that she will also conduct an in service training with staff regarding the storage of medication. The Executive Director agreed to provide LPA proof of training via email or fax by POC due date.

Deadline recorded: May 27, 2026. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87465(a)(5)

Regulation authority

CCR

What the official deficiency says

87465 Incidental Medical and Dental Care: (a) A plan for incidental medical and dental care shall be developed...(5) Facility staff, except those authorized by law, shall not administer injections.. This requirement is not evidenced by: Based on interviews conducted, the Licensee did not ensure that a medical profession administered injections to R1. LPA received an admission from R1 and three staff who corroborated the allegation. This poses an immediate health and safety risk to persons in care.

Official plan of correction

The Executive Director stated that she create a plan to ensure that injections are only administered to R1 by a medical professional. The Executive Director stated that she will also conduct an in service training with staff regarding injections. The Executive Director agreed to provide LPA the plan and the in service training via email or fax by POC due date.

Deadline recorded: May 27, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87465(a)(5)

Regulation authority

CCR

What the official deficiency says

87465 Incidental Medical and Dental Care: (a) A plan for incidental medical and dental care shall be developed by each facility...(4) The licensee shall assist residents with self-administered medications as needed. This requirement is not evidenced by: Based on records reviewed, the Licensee did not ensure that each resident's as needed medications were present at the facility if needed by the resident. This poses a potential health, safety, and personal rights risk to persons in care.

Official plan of correction

The Executive Director stated that she will either discontinue the as needed medications, or order refills for them to be present at the facility. The Executive Director also stated that she will conduct an in service training with staff regarding medication management. The Executive Director agreed to provide LPA proof of the in service training via email or fax by POC due date.

Deadline recorded: Jun 8, 2026. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87464(f)(1)

Regulation authority

CCR

What the official deficiency says

Basic Services 87464(f)(1) Basic services shall at a minimum include: Care and supervision as defined in Section 87101(c)(3) and Health and Safety Code section 1569.2(c). This requirement is not met as evidence by: The Licensee failed to identify fall preventative measures needed to meet R1’s needs resulting in R1 sustaining a second fall with closed fracture diagnosis. This poses an immediate risk to resident’s health and safety.

Official plan of correction

AD stated logs have been implemented to record safety check per resident in memory care. Furthermore, iPad will be issued to staff to ensure residents are being check on an hourly basis in the future. AD will provide copies of logs and in-service training by POC due date.

Deadline recorded: Jan 24, 2026. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87465(a)(1)

Regulation authority

CCR

What the official deficiency says

Incidental Medical and Dental Care 87465(a)(1) The licensee shall arrange, or assist in arranging, for medical and dental care appropriate to the conditions and needs of residents. This requirement was not met as evidence by: The Licensee did not follow up with R1’s primary care physician as instructed per hospital discharge paperwork following R1’s fall on 5/26/25. This poses an immediate risk to resident’s health and safety.

Official plan of correction

AD stated in-service training will be performed with staff specifically on reviewed discharge documents and instructions. AD to provide proof of training by POC due date.

Deadline recorded: Jan 24, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87463(c)(3)

Regulation authority

CCR

What the official deficiency says

Reappraisals 87463(c)(3) … the licensee shall document all of the following in the resident’s reappraisal: Interventions to be implemented to minimize the risks to the health and safety of the resident or others associated with the resident's behavioral expression… This requirement is not met as evidence by: The Licensee failed to document interventions to be implemented to minimize falls after identifying R1 as a fall risk. This poses a potential risk to resident’s health and safety.

Official plan of correction

AD stated R1 is on home health for physical therapy once per week. In addition, R1 has been placed on hour checks which are documented in a log. AD to provide proof of physical therapy and logs by POC due date.

Deadline recorded: Jan 30, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87507(f)

Regulation authority

CCR

What the official deficiency says

87507(f) Admission Agreements The licensee shall comply with all applicable terms and conditions set forth in the admission agreement, including all modifications and attachments. The requirement is not met as evidenced by: The facility did not adhere to a 90 day rate increase notice as indicated in R1's admission agreement which poses a potential personal rights risk to persons in care.

Official plan of correction

AD stated a new rate increase letter will be issued to R1 to reflect a 90 notice. AD to send proof to LPA by POC due date.

Deadline recorded: Nov 20, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87412(a)(11)

Regulation authority

CCR

What the official deficiency says

(a) The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. Each personnel record shall contain the following information: (11) A health screening as specified in Section 87411, Personnel Requirements - General. This requirement is not met as evidenced by: Deficient Practice Statement Based on record review, the licensee did not comply with the section cited above in 3 out of 5 staff files which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/27/2024 Plan of Correction Licensee agrees to have staff with no health screening, to be screened by a physician and to provide the Health screening form (LIC 503) on file for each staff member. Proof to be forwarded to LPA by POC due date.

Official classification

Type B

Official code

1569.625(b)(2)

Regulation authority

HSC

What the official deficiency says

(2) In addition to paragraph (1), training requirements shall also include an additional 20 hours annually, eight hours of which shall be dementia care training, as required by subdivision (a) of Section 1569.626, and four hours of which shall be specific to postural supports, restricted health conditions, and hospice care, as required by subdivision (a) of Section 1569.696. This training shall be administered on the job, or in a classroom setting, or both, and may include online training. This requirement is not met as evidenced by: Deficient Practice Statement Based on record review, the licensee did not comply with the section cited above in 2 out of 2 caregiver files which poses/posed a potential health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 06/27/2024 Plan of Correction Licensee agrees to have all training documented for caregivers and to provide proof of training for caregivers LPA by the POC due date.

Official classification

Type B

Official code

87303(e)(6)

Regulation authority

CCR

What the official deficiency says

Maintenance and Operation. Water supplies and plumbing fixtures shall be maintained as follows: Toilet, handwashing and bathing facilities shall be maintained in operating condition. This requirement was not met as evidenced by: based on record review and interview the Licensee did not ensure the toilets were properly maintained. This poses a potential risk to the health & safety of residents in care.

Official plan of correction

The citation was cleared at the time of this visit as the issue was previously addressed.

Deadline recorded: Jun 14, 2023. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87465(g)

Regulation authority

CCR

What the official deficiency says

Incidental Medical and Dental Care. The licensee shall immediately telephone 9-1-1 if an injury or other circumstance has resulted in an imminent threat to a resident’s health...specified in Sections 87469...or (c)(4). This requirement is not met as evidenced by: based on resident record review & interviews conducted the licensee failed to call 911 following R1’s unwitnessed fall on 04/10/2022. This poses an immediate risk to the health & safety of residents in care.

Official plan of correction

Licensee will provide staff an in-service training regarding this regulation by June 25, 2023. Licensee to provide the name of the instructor, their qualifications, and submit written proof of the staff training to LPA by POC due date. The licensee to provide LPA a written statement indicating they have read this section of Title 22 regulation and how exactly they intend to adhere to it by POC due date.

Deadline recorded: Jun 15, 2023. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87466

Regulation authority

CCR

What the official deficiency says

Observation of the Resident. The Licensee to ensure that residents are regularly observed for changes in physical, mental, emotional and social functioning and that appropriate assistance is provided when such observation reveals unmet needs. This requirement is not met as evidenced by: based on resident record review & interviews conducted the licensee failed to observe R1’s change in condition following the unwitnessed fall on 04/10/2022.

Official plan of correction

The Licensee to ensure that residents are regularly observed for changes and that appropriate assistance is provided when such observation reveals unmet needs. Licensee to provide staff an in-service training regarding this regulation. Licensee to provide the name of the instructor, their qualifications, and submit written proof of the staff training to LPA by POC due date of June 25, 2023.

Deadline recorded: Jun 15, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87211(a)(1)(A)

Regulation authority

CCR

What the official deficiency says

Reporting Requirements. Each Licensee shall furnish...reports as the Department may require...the following: A written report shall be submitted to the licensing agency and to the person responsible for the resident seven days of the occurrence of...events specified in (A)...below. This requirement is not met as evidenced by: based on resident record review & interviews conducted the Licensee failed to submit an Incident & Death Report to Licensing for R1. This poses a potential risk to the health and safety of the residents in care.

Official plan of correction

The Licensee to ensure written reports are submitted to the Department pursuant to this regulation. The Licensee to provide LPA a written statement indicating they have read this section of Title 22 regulation and how exactly they intend to adhere to it by POC due date.

Deadline recorded: Jun 16, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

1569.269(a)(21)

Regulation authority

HSC

What the official deficiency says

Enumerated rights; severability. Residents of residential care facilities for the elderly shall have all of the following rights: To have prompt access to review all of their records and to purchase photocopies...records shall be promptly provided, not to exceed two business days. This requirement is not met as evidenced by the Licensee's failure to provide R1's records to their legal representative. This poses a potential risk to the health & safety of residents in care.

Official plan of correction

The Licensee to ensure it provides resident records to their responsible party or legal representative pursuant to statute and regulation. The Licensee to provide LPA a written statement indicating they have read this section of the HSC and how exactly they intend to adhere to it by POC due date.

Deadline recorded: Jun 16, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

1569.652(c)

Regulation authority

HSC

What the official deficiency says

Termination of admission agreement upon death of resident; removal of resident’s property; refund of fees paid; notice of contract termination and refunds...removed. This requirement is not met as evidenced by: based on resident record review and interviews conducted, the Licensee failed to provide a refund of monies due R1’s family. This poses a potential risk to the health and safety of residents in care.

Official plan of correction

The Licensee to ensure it provides refunds of funds paid in advance pursuant to statute and regulation. The Licensee to provide LPA a written statement indicating they have read this section of the HSC and how exactly they intend to adhere to it by POC due date.

Deadline recorded: Jun 16, 2023. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87465(c)(2)

Regulation authority

CCR

What the official deficiency says

Incidental Medical and Dental Care. If the resident's physician... provided all of the following requirements are met: Once ordered by the physician the medication is given according to the physician's directions. This requirement is not met as evidenced by: based on record review and interview the Licensee did not ensure the medications for R1 and R2 were given according to physician's orders. This poses an immediate risk to the health & safety of residents in care.

Official plan of correction

Licensee to ensure all medications are given in accordance to doctor's orders at all times. Licensee to obtain the missing medications for R1 and R2 and submit written proof to LPA by POC due date. Licensee to submit a written statement to LPA indicating they have read this section of regulation and how they intend to adhere to it by POC due date.

Deadline recorded: Apr 27, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87303(a)

Regulation authority

CCR

What the official deficiency says

Maintenance and Operation. The facility shall be clean, safe, sanitary and in good repair at all times. This requirement was not met as evidenced by: based on interview and record review the facility did not ensure the furnace and AC units were in operating condition. This poses a potential risk to the health and safety of residents in care.

Official plan of correction

Licensee to ensure the furnace and AC units are in operating condition at all times. The furnace and AC units have been repaired and all is in working order as of this visit. THE CITATION IS NOW CORRECTED AND CLEARED. Clearance letter provided at the time of this visit.

Deadline recorded: Mar 9, 2023. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87303(e)(2)

Regulation authority

CCR

What the official deficiency says

87303(e)(2) Maintenance and Operation. Water supplies and plumbing fixtures shall be maintained as follows: Faucets used by residents for personal care such as shaving and grooming shall deliver hot water. Hot water temperature controls shall be maintained to automatically regulate the temperature of hot water used by residents to attain a temperature of not less than 105 degree F (41 degree C) and not more than 120 degree F (49 degree C). Deficient Practice Statement Based on observation, the licensee did not comply with the section cited above in 3 out of 10 bathrooms where the hot water temperature exceed 120 degrees F which poses an immediate health, safety or personal rights risk to persons in care.

Official plan of correction

POC Due Date: 05/14/2022 Plan of Correction Licensee to ensure the hot water temperature is maintained pursuant to regulation and submit written proof to LPA by POC due date.