<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 019200509
Report Date: 06/30/2026
Date Signed: 06/30/2026 12:48:11 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/09/2026 and conducted by Evaluator Kelly Nguyen
COMPLAINT CONTROL NUMBER: 15-AS-20260609084311
FACILITY NAME:PACIFICA SENIOR LIVING UNION CITYFACILITY NUMBER:
019200509
ADMINISTRATOR:LAGASCA-CRUZ, MARIE ANNFACILITY TYPE:
740
ADDRESS:33883 ALVARADO NILES RDTELEPHONE:
(510) 489-3800
CITY:UNION CITYSTATE: CAZIP CODE:
94587
CAPACITY:110CENSUS: 65DATE:
06/30/2026
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Marissa Baldeomero, Director/ Resident Services Director TIME COMPLETED:
01:10 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff are not assisting resident with obtaining medication from pharmacy
Staff are not assisting resident with transportation
Staff are financially abusing resident
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 06/30/2026 at 9:30 AM, Licensing Program Analyst (LPA) K. Nguyen arrived unannounced to deliver findings for the allegations above. LPA met with Memory Care Director/ Resident Services Director Marissa Baldeomero and explained the purpose of the visit. LPA was informed that Executive Director Marie Lagasca Cruz was out of the community and unavailable.

During the course of the investigation, the Licensing Program Analyst (LPA) conducted interviews with Resident 1 (R1), Resident 2 (R2), Resident 3 (R3), Resident 4 (R4), Resident 5 (R5), Resident 5 (R5), Resident 6 (R6), and Resident 7 (R7), and facility staff, and reviewed relevant records and documentation. Documents reviewed included, but were not limited to, R1’s medication administration records (MAR), physician’s orders, medication logs, pharmacy records, resident file, care plan, and facility policies and procedures related to medication assistance and medication management.

Report continued on LIC 9099c...
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Kelly Nguyen
LICENSING EVALUATOR SIGNATURE:

DATE: 06/30/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/30/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 4
Control Number 15-AS-20260609084311
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME: PACIFICA SENIOR LIVING UNION CITY
FACILITY NUMBER: 019200509
VISIT DATE: 06/30/2026
NARRATIVE
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
Report continued...

It was alleged that facility staff are not assisting residents with obtaining medication from the pharmacy. During the investigation, Licensing Program Analyst (LPA) conducted interviews with Resident 1 (R1), Resident 2 (R2), Resident 3 (R3), Resident 4 (R4), Resident 5 (R5), Resident 6 (R6), Resident 7 (R7), Staff 1 (S1), and Staff 2 (S2), and reviewed relevant records, including care plan. Resident interviews revealed that facility staff routinely assist residents with coordinating medication refills and obtaining medications from the pharmacy based on each resident's assessed needs and the facility's medication assistance procedures. S1 and S2 stated that requests for medication refills and pharmacy pick-up are documented and completed as appropriate. R1 was unable to provide specific information, such as dates, missed medications, or instances in which staff refused or failed to assist with obtaining medications. LPA reviewed R1's care plan, which documents that R1 is designated as self-administered for medications. The care plan specifies that R1 is responsible for managing medications, including obtaining prescription refills and picking up medications from the pharmacy, in accordance with facility policy.

Based on interviews and records reviewed, there was insufficient evidence to support the allegation that facility staff are not assisting residents with obtaining medication from the pharmacy. The evidence indicates that residents who require medication assistance receive such assistance, while R1 is responsible for medication management under the agreed-upon care plan. Therefore, although the allegation may have occurred or is valid, there is insufficient evidence to prove the alleged violation occurred, and the allegation is Unsubstantiated.

Report Continued on LIC 9099c1...
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Kelly Nguyen
LICENSING EVALUATOR SIGNATURE:

DATE: 06/30/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/30/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 15-AS-20260609084311
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME: PACIFICA SENIOR LIVING UNION CITY
FACILITY NUMBER: 019200509
VISIT DATE: 06/30/2026
NARRATIVE
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
Report Continued LIC 9099c1...

It was alleged that facility staff are not assisting residents with transportation. During the investigation, the Licensing Program Analyst (LPA) conducted interviews with Resident 1 (R1), Resident 2 (R2), Resident 3 (R3), Resident 4 (R4), Resident 5 (R5), Resident 6 (R6), Resident 7 (R7), and facility staff. LPA also reviewed relevant facility records, including transportation schedules and transportation sign-up sheets. Interviews with residents consistently indicated that the facility provides transportation assistance when requested. The transportation records reviewed corroborate that residents are scheduled for and transported to appointments and other approved destinations in accordance with facility procedures. R1 acknowledged that the facility does provide transportation services, stating that "the facility does accommodate when rides are requested at the last minute." No interviewed residents reported being denied transportation assistance.

Based on interviews and records reviewed, there was insufficient evidence to support the allegation that facility staff are not assist residents with transportation. Therefore, although the allegation may have occurred or is valid, there is insufficient evidence to prove the alleged violation occurred, and the allegation is deemed Unsubstantiated.

Report Continued on LIC 9099c2...
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Kelly Nguyen
LICENSING EVALUATOR SIGNATURE:

DATE: 06/30/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/30/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 15-AS-20260609084311
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME: PACIFICA SENIOR LIVING UNION CITY
FACILITY NUMBER: 019200509
VISIT DATE: 06/30/2026
NARRATIVE
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
Report Continued LIC 9099c2...

It was alleged that staff are financially abusing residents. During an interview, Staff 1 (S1) stated that R1 was originally admitted as an independent resident and later transitioned to the assisted living program in approximately March 2026 following hip surgery. S1 explained that despite the transition, R1 has always managed personal financial independently. S1 further stated that in approximately April 2026, R1 expressed concern about being behind on rent payments due to multiple hospitalization and requested assistance with establishing automatic monthly rent payments. According to S1, R1 authorized the automatic payment process on 4/14/2026. S1 explained that the authorization paperwork was submitted to the facility's corporate office for processing, as the facility does not process automatic payment requests on-site. Before the authorization was fully processed, R1 provided a personal check for the monthly rent on 4/16/2026, which the facility accepted and deposited that same day. S1 stated that the corporate office also processed the automatic payment effective 4/16/2026, resulting in both transactions occurring.

S1 reported that on 4/21/2026, S1 met with R1 to explain why both payments had been processed and to reassure R1 that the duplicate payment would be applied as a credit toward the following month's rent. S1 stated that R1 was informed there would be no financial loss and that the credit would satisfy the next month's payment obligation. LPA confirmed with R1 that R1 is aware, has spoken with S1 regarding the issue, and that it has been resolved.

Based on staff interviews and the information obtained during the investigation, there was insufficient evidence to support that the facility staff are not financially abusing residents. The evidence indicates that the duplicate payment resulted from the timing of R1's request to establish automatic payments and the submission of a personal check before the authorization process was completed. Therefore, the allegation is Unsubstantiated.

An exit interview was conducted, and a copy of this report was provided.
SUPERVISORS NAME: Bennett Fong
LICENSING EVALUATOR NAME: Kelly Nguyen
LICENSING EVALUATOR SIGNATURE:

DATE: 06/30/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/30/2026
LIC9099 (FAS) - (06/04)
Page: 4 of 4