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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107208866
Report Date: 08/03/2021
Date Signed: 08/03/2021 04:10:43 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME:VISTA ELDERLY CARE FACILITYFACILITY NUMBER:
107208866
ADMINISTRATOR:ABALOS, CORAFACILITY TYPE:
740
ADDRESS:8893 NORTH SIERRA VISTA AVETELEPHONE:
(559) 470-2062
CITY:FRESNOSTATE: CAZIP CODE:
93720
CAPACITY:6CENSUS: 3DATE:
08/03/2021
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
10:10 AM
MET WITH:Assistant Administrator, Leticia RodriguezTIME COMPLETED:
10:35 AM
NARRATIVE
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On 08/03/2021, Licensing Program Analysts (LPAs) Walton and Yang conducted an unannounced, Case Management - Deficiencies visit. LPAs met with Assistant Administrator, Leticia Rodriguez. LPAs introduced themselves and disclosed the purpose of the visit.

During the course of a complaint investigation LPA found the following:

Per review of the Needs and Services Plan, Resident R1 should have received showers from female staff only. Consistent statements from interviews revealed that the Needs and Services Plan was not followed for R1 and R1 was "forced" to receive showers from both male and female staff.

On 07/20/2021, 07/23/2021, and 08/03/2021 LPA conducted unannounced visits to the above facility. During each visit, an Administrator was not present. Upon review of facility staff schedule, it was found that an Administrator is not scheduled to manage the facility and an Administrator is available "as needed". Consistent statements from interviews, revealed that the Administrator is not present in the facility.

Based on observation, record review and interviews, deficiencies are being cited in accordance with California Code of Regulations, Title 22, Division 6 on the attached 809D.

Exit interview was conducted and a Plan of Correction was reviewed and developed. As a COVID-19 precautionary measure, a copy of this report and Appeal Rights will be provided via email and an electronic read receipt confirms receiving these documents. Facility Representative signature on file.
SUPERVISOR'S NAME: Melinda HoffmannTELEPHONE: (559) 650-7914
LICENSING EVALUATOR NAME: Alexandria WaltonTELEPHONE: (559) 246-0128
LICENSING EVALUATOR SIGNATURE:

DATE: 08/03/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/03/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1314 E SHAW AVE
FRESNO, CA 93710

FACILITY NAME: VISTA ELDERLY CARE FACILITY
FACILITY NUMBER: 107208866
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/03/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/04/2021
Section Cited

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87468.1 Personal Rights of Residents in All Facilities: (a) Residents...shall have all of the following personal rights: (1) To be accorded dignity in their personal relationships with staff. This requirement was not met as evidenced by:
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Based on interviews and records review, the Licensee did not ensure residents were accorded dignity in their personal relationships with Staff when R1 was "forced" to receive showers from both male and female staff. This poses an immediate health and safety risk to residents in care.
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Licensee agrees tthat staff will be trainied on Personal Rights Regulations. Documentation of traning topics and attendance will be submitted to the Fersno CCL office by 09/03/2021.
Type B
09/03/2021
Section Cited

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87405 Administrator - Qualifications and Duties: (a) All facilities shall have a qualified and currently certified administrator...The administrator shall have sufficient freedom from other responsibilities and shall be on the premises a sufficient number of hours to permit adequate attention to the management and administration...This requirement was not met as evidenced by:
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Based on observation, record review, and interviews, the Licensee did not ensure a qualified Administrator was on the premises for a sufficient number of hours to manage the facility. This poses a potential health and safety risk to 3 out of 3 residents in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Melinda HoffmannTELEPHONE: (559) 650-7914
LICENSING EVALUATOR NAME: Alexandria WaltonTELEPHONE: (559) 246-0128
LICENSING EVALUATOR SIGNATURE:
DATE: 08/03/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/03/2021
LIC809 (FAS) - (06/04)
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