Pacifica Senior Living South Coast.

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 licensed for 98 non-ambulatory residents of which 20 may be bedridden. Facility has an approved hospice waiver for 20 residents. Executive Director (ED) Yaylene Mazariegos was present to conduct facility tour. ED has a valid certificate that expires on 08/16/2026. ED provided proof of liability insurance which expires on 10/18/2026. LPA along with ED toured the facility at 9:00 AM. LPA toured the physical plant, checked food service, and facility documentation. The facility is a 2 story building with a secured memory care unit on the first floor. Seven resident bedrooms checked had the required furniture, bed linens and closet/drawer space to accommodate each resident comfortably. Seven resident bathrooms were checked. Toilets and water faucets worked properly, grab bars were secure and showers were free of mold/mildew. Water temperature measured between 107.7 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 observed memory care delayed egress exits are operational. LPA and the ED toured the kitchen and dining room. The kitchen is clean and organized. LPA observed a 2 day perishable and a 7 day non-perishable food supply on hand in the kitchen. LPA observed the refrigerator and freezer were operational. LPA checked refrigerator logs and observed meal preparation for lunch. Fire extinguishers observed were fully charged. LPA observed the call system is operational. LPA observed the call response time is less than eight minutes. LPA observed emergency evacuation chairs at each stairwell. LPA observed there is outdoor shaded seating areas for memory care and assisted living. There are no bodies of water in the outdoor areas of the facility. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 LPA reviewed the fire alarm system paperwork showing the system passed its annual inspection on 3/20/2026. LPA observed residents spending time in their rooms and walking along the halls. LPA observed several residents in the memory care area watching television in the community room. 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 04/14/2026. First aid kit contained all required items including tweezers, scissors and thermometer. Facility conducts activities in the form of exercise, music therapy, games, and outings. LPA observed the emergency food and water supply. LPA reviewed seven resident files and five 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 carts 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.

This unannounced inspection is being conducted by Licensing Program Analyst (LPA) Fred Arias for the purpose of a health and safety check. LPA met with Administrator (AD) Yaylene Mazariegos and explained the purpose of the inspection. During the inspection, LPA and AD toured the facility. LPA conducted health and safety checks on the residents and confirmed they were doing well and observed no health and safety issues. LPA observed the facility to be clean and organized and found no health and safety issues. LPA requested and reviewed copies of Resident 1 (R1) files. An exit interview was conducted and a copy of this report was discussed with and provided to facility representative.

This unannounced inspection is being conducted by Licensing Program Analyst (LPA) Fred Arias for the purpose of a health and safety check. LPA met with Administrator (AD) Yaylene Mazariegos and explained the purpose of the inspection. During the inspection, LPA and AD toured the facility. LPA conducted health and safety checks on the residents and confirmed they were doing well and observed no health and safety issues. LPA observed the facility to be clean and organized and found no health and safety issues. LPA observed the facility has a 2-day supply of perishables and a 7-day supply of non-perishable food is available as required by regulations. LPA observed the electricity and water were running and the medications were properly stored. LPA requested and reviewed copies of the resident roster, staff roster, and resident files. An exit interview was conducted and a copy of this report was discussed with and provided to facility representative.

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 licensed for 98 non-ambulatory residents of which 20 may be bedridden. Facility has an approved hospice waiver for 20 residents. Executive Director (ED) Yaylene Mazariegos arrived shortly to conduct facility tour. ED has a valid certificate that expires on 08/16/2026. ED provided updated liability insurance that expires on 01/01/2026. LPA along with ED toured the facility at 9:40 AM. LPA toured the physical plant, checked food service, and facility documentation. The facility is a 2 story building with a secured memory care unit on the first floor. Five resident bedrooms checked had the required furniture, bed linens and closet/drawer space to accommodate each resident comfortably. Five resident bathrooms were checked. Toilets and water faucets worked properly, grab bars were secure and showers were free of mold/mildew. Water temperature measured between 105.4 degrees F and 115.8 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 observed memory care delayed egress exits are operational. LPA and the ED toured the kitchen and dining room. The kitchen is clean and organized. LPA observed a 2 day perishable and a 7 day non-perishable food supply on hand in the kitchen. LPA observed the refrigerator and freezer were operational. Fire extinguishers observed were fully charged. LPA observed cleaning supplies are kept locked in a storage closet. LPA observed the call system is operational. LPA observed the call response time is less than 5 minutes. LPA observed emergency evacuation chairs at each stairwell. LPA observed there is outdoor shaded seating areas for memory care and assisted living. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 No bodies of water in the outdoor areas of the facility. LPA reviewed the fire alarm system paperwork showing the system passed its annual inspection on 3/5/2025. 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 3/10/2025. First aid kit contained all required items including tweezers, scissors and thermometer. Facility conducts activities in the form of exercise, music therapy, games, and outings. LPA observed the emergency food and water supply. LPA reviewed five resident files and five 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 cabinets in the medication room. Medications are being administered per physician order. 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.

On this day at 11am, a meeting was conducted by Assistant Program Administrator (APA) Stacy Barlow to verify Chapter 7 Bankruptcy Report filed by the Pacifica Senior Living as reported by the media. Present during the meeting are: Shelly Gracce - Assistant Branch Chief, CCLD Craig Lundgren - Legal Counsel, CCLD Carl Knepler - Chief Executive Officer, Marlene Nelson - Director, Quality Assurance and Risk Management APA Barlow verified with Knepler information received by CCL from the media as follows: $25M lawsuit against the community located in Bakersfield Phtography lawsuit against one of the properties lawsuit against a Killed Nursing Facility (SNF) in the Healdsburg location Knepler states that despite the lawsuits, there is no financial impact to any of the properties, residents or staff of the company. Knepler added there are no vendor issues as well. continuation on Lic 809C ***Original signature on file with the Pacifica Senior Living Union City facility.*** 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 Knepler also states that management communicates with the staff and residents to make them aware of the changes. Signages have been changed. Knepler added that the bankruptcy did not affect any of the communities because Pacifica Senior Living Management was no longer the management company for any of the Pacifica Communities, that the communities had given notice to the department and residents back in October or November of last year of the changes in management companies. He said that the judgment in Bakersfield did not involve the operating entity, only the management company. He said there were no other suits pending against any of the Pacifica entities. APA requested the following documents be provided to CCL by today: Spread sheet of all facilities whose management company was/is Pacifica Senior Living Management Company management companies for each location letter provided to the residents notifying them of the changes At the conclusion of the meeting, APA emphasized to Knepler the importance of communicating with CCL any lawsuits that the company may have in the future. Knepler agreed with APA. A copy of this report was provided to Knepler. *** Original signature on file with the Pacifica Senior Living Union City facility.***

Per interview with Executive Director Yaylene Mazariegos there is 1 LVN available Monday - Friday, 1 med-tech on every shift, 1 caregiver for assisted living and 2 caregivers for memory care for AM and PM shifts. Overnight staff is 1 med-tech and 1 caregiver. ED also stated all staff are trained to provide care to residents. Interviews with 2 out of 2 staff stated they are able to assist residents with activities of daily living with the current staffing ratios. Per interviews with 2 out of 2 residents they indicated staff is responsive and assists them as needed. ED stated there is a resident in Memory Care that will wander into other residents rooms and staff will redirect. ED stated most Assisted Living residents are ambulatory and can ask for assistance. LPA Mendivil observed staff responding to pendant calls during the visit. Interviews with 2 out of 2 residents stated they have not had any issues with hygiene supplies not being available. Residents stated they can ask for hygiene items and the facility will provide them. Per interview with ED, ED stated all except 3 residents in memory care under incontinent care. ED stated the facility provides wipes, briefs and incontinent pads if a resident is under the incontinent care program. ED stated if a resident is not under the incontinent care plan then the resident or resident's family is to provide briefs and wipes. ED stated if a resident that is not under incontinent care plan and runs out of supplies the facility will provide supplies as needed. LPA Mendivil observed a closet with extra supplies ready and available to all staff. Therefore based on the preponderance of evidence through interviews and observations the allegations that Facility does not have adequate staffing and Facility does not provide adequate hygiene supplies are determined to be UNSUBSTANTIATED, meaning that although the allegation may have happened or are valid, there is not a preponderance of evidence to prove that the alleged violation occurred. This agency has investigated this complaint. No deficiencies cited. An exit interview was conducted and a copy of this report this report was left at the facility.

It is alleged facility did not provide R1's authorized representative with written refund policy in a timely manner. During their interview, R1’s RP denied the facility not providing them with written refund policy in a timely manner. LPA also obtained and reviewed a copy of R1's facility refund agreement signed and dated December 16, 2019. The Department has investigated the complaint alleging staff prevented resident's medical professional from caring for resident and facility did not provide resident's authorized representative with written refund policy in a timely manner. After interviews conducted with facility residents, witness, and R1's RP, We have found that the complaint was 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 this report was provided at the end of the inspection. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 Four of four residents interviewed were unable to corroborate allegation and stated they receive medical attention as needed and in a timely manner. Three of three staff interviewed denied medical attention being delayed or denied to any resident and stated medical attention is sought in a timely manner for all residents. It is alleged staff did not safeguard R1’s personal belongings. Interviews were conducted with R1’s RP, three facility staff, and four residents. During their interview, RP stated that R1's Ipad was stolen at the facility and was never recovered. Three staff of three staff interviewed denied having any knowledge of R1’s Ipad being stolen and stated missing property or valuables have not been reported by any other resident or their responsible party. Four of four residents interviewed could not corroborate the allegation and denied having any missing property or valuables. It is alleged facility did not answer communications from R1’s authorized representative promptly. Interviews were conducted with R1’s RP, three facility staff, and four residents. During their interview, RP stated that due to the pandemic, they were unable to visit R1 and there were days when they were unable to get a hold of R1 by phone. RP stated R1 had a phone and knew how to use it, however R1 was also hard of hearing and would often go without answering their phone because they could not hear it. Per RP, the facility for their part was responsive and they did not have any concerns. Three staff of three staff interviewed denied allegation and stated there is ongoing communication between the facility and residents’ authorized representatives, if any. Four of four residents interviewed also denied the allegation and stated the facility and facility staff have ongoing communication with their authorized representatives. Due to conflicting information received during interviews conducted, LPA is unable to determine if staff did not seek medical attention for resident in a timely manner, if staff did not safeguard resident's personal belongings, or if the facility did not answer communications from authorized representative promptly. Although the above allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore at this time the above allegations are unsubstantiated. An exit interview was conducted and copy of this report was provided at the end of the inspection.

Regarding the allegation that facility did not safeguard resident's cellphone which led to its theft: it was alleged that R1’s cell phone went missing from their room, staff searched for the phone and could not find it, the phone reappeared in R1’s room a few days after it went missing without explanation, and one of R1’s hearing aids also went missing. LPA inspected the facility, conducted health and safety checks on residents present, and observed no health and safety issues. LPA interviewed AD who stated that R1 is no longer a resident of the facility, there are no major issues regarding theft and loss at the facility, the facility does not handle or store resident property, and residents are responsible for safeguarding the property they bring into the facility. LPA interviewed Staff #1 (S1), the staff who oversaw the investigation into R1’s missing property, who denied the allegation. S1 denied there are major issues regarding theft or loss at the facility, stating that most lost items were later found. S1 stated they investigated the loss of R1’s cell phone and hearing aid and did not obtain information that they were stolen. LPA interviewed six residents and obtained information that there was at least one other alleged theft approximately two years ago that was investigated by the police, but the police could not identify the suspect and LPA did not obtain information that there are systemic issues of theft at the facility. LPA interviewed two out of two care staff present and did not obtain information corroborating the allegation. The information obtained did not corroborate that R1’s missing items were stolen, that there is a systemic issue of theft at the facility, or that the facility’s theft and loss policies are inadequate. The information obtained did not corroborate the allegation. Regarding the allegation that the facility did not follow their theft and loss policy regarding the theft of resident's cellphone: it was alleged that R1’s cell phone and hearing aid went missing, the facility was aware of another resident who sometimes takes other residents’ property but did not search this resident’s room for the missing items, and the facility did not investigate the thefts, review camera footage, or call the police. LPA inspected the facility, conducted health and safety checks on residents present, and observed no health and safety issues. LPA reviewed R1’s Admission Agreement which indicates that the facility’s theft and loss policy states that the facility will create an inventory of each resident’s personal items brought into the facility and the facility will not be responsible for items not on that inventory. Per R1’s Admission Agreement, R1’s personal property inventory, which R1 signed, did not include R1’s cell phone or hearing aid. LPA interviewed AD who stated that there are no major issues regarding theft and loss at the facility, the facility does not handle or store resident property, and residents are responsible for safeguarding the property they bring into the facility. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 LPA interviewed S1, the staff who oversaw the investigation into R1’s missing property, who denied the allegation. Per S1, the facility’s theft and loss policy is that the facility is not responsible for missing items unless the loss was caused by the facility, but that the facility will investigate lost property, determine what happened, and punish those responsible and that the facility followed this policy with regards to R1’s missing items. S1 stated that when R1’s phone went missing, R1’s room was searched, multiple staff were interviewed, R1’s family was contacted, the transport company that R1 used was also contacted, and staff found the phone a few days after it was missing and returned it to R1. Regarding the missing hearing aid, S1 stated they interviewed staff and could not locate the hearing aid. Regarding the other resident who sometimes takes other residents’ property, S1 confirmed that this resident has a history of taking other residents’ property, but stated that this resident’s room was searched for both the cell phone and hearing aid and neither item was found in their room. S1 also stated they reviewed camera footage which did not reveal information helpful to the investigation. While the facility’s theft and loss policy states stolen items must be reported to law enforcement, the facility’s investigation did not determine that R1’s hearing aid was stolen. The information obtained did not corroborate that the facility did not properly investigate R1’s missing items or otherwise not follow its theft and loss policy. The information obtained did not corroborate the allegation. Based on the information gathered during the investigation and review of all documents obtained, the Department is unable to ascertain if the above allegations occurred as reported. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove or refute the alleged violations occurred; therefore, these allegations are deemed Unsubstantiated. An exit interview was conducted and a copy of this report was discussed with and provided to facility representative.

Licensing Program Analyst (LPA) Kimberly Lyman conducted an unannounced health and safety case management visit in conjunction with an SOC 341 received by the department on 06/24/2024. LPA was greeted and granted entry by Administrator Stacie Anderson and explained the reason for the visit. During the visit, LPA toured the facility and observed the following: Facility is clean and sanitary and consists of two floors housing assisted living and memory care units. There are 35 residents present during today's visit. Facility has ample food in supply and LPA observed residents dining. LPA toured the memory care unit and observed residents relaxing in the dining room. LPA spoke with residents who expressed satisfaction with facility and verbalized being safe in the facility. LPA reviewed and obtained records for Resident 1 including physician report, pre-appraisal and medication orders. LPA observed no health or safety concerns during today's visit. Exit interview conducted and a copy of this report was left at the facility.

It was alleged that the facility staff are not properly trained. LPA De Perio conducted a total of 9 interviews, of which all 6 resident interviews, and all 3 staff interviews did not corroborate with the allegation. All 6 resident interviews also confirmed that there were no health or safety concerns regarding staff and their training. Per documentation review, each staff member undergoes training that consists of hands-on orientation and shadowing, video tutorials, completion of tests and certifications. It was alleged that the facility does not provide activities to residents. LPA De Perio conducted a total of 9 interviews, of which all 6 resident interviews, and all 3 staff interviews did not corroborate with the allegation. During the tour of the physical plant of the facility, LPA De Perio observed that there is an activity calendar posted in the hallway of the facility and at the front desk for the entirety of the month. Per activity calendar, there are ongoing daily activities both in the assisted living and memory care portion of the facility, and is led by the facility activities director. Per documentation review, LPA De Perio observed photos of residents engaging in activities at the facility such as participating in games, pet therapy, arts and crafts, music, and outdoor activities. It was alleged that there is lack of care and supervision. LPA De Perio conducted a total of 9 interviews, of which all 6 resident interviews, and all 3 staff interviews did not corroborate with the allegation. 4 of the resident interviews specified about how “great” the staff was and disclosed their satisfaction with the facility. Per documentation review, it was observed that if a resident needs medical care or an evaluation, the facility contacts the resident’s medical team in a timely manner. 1 interview conducted with staff also specified that regardless of the staff’s position, each staff is trained on caring for a resident, reporting requirements and trained on obtaining medical assistance. It was alleged that facility is understaffed. LPA De Perio conducted a total of 9 interviews, of which all 6 resident interviews, and all 3 staff interviews did not corroborate with the allegation. All 3 staff interviews and 2 resident interviews specified that if there is a call-out for a care staff, the facility administrator, Health and Wellness director, or additional personnel with the qualifications, will obtain the shift to ensure coverage is met in the area needed. Per documentation review of the staff schedule, and monthly schedule from August 2023 to October 2023, LPA observed that there was a minimum of 2 caregivers, 2 med-techs, and 1 nurse, per shift. For night supervision, it was also observed that there is a designated staff member on-call to attend to the facility if needed. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 Based on LPA’s interviews which were conducted, review of documents obtained, and observations, LPA is unable to ascertain if the allegations occurred as reported. Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove or refute the alleged violations occurred; therefore, the allegations are deemed UNSUBSTANTIATED. An exit interview was conducted with CRD Melendez and BOM Castro. A copy of this report was provided and explained.

Based on LPA’s interviews which were conducted, review of documents obtained, this allegation was UNFOUNDED, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. For today's visit, no citations were issued. An exit interview was conducted with ED Anderson. A copy of this report was explained.