197610286-7-21-2026-31-AS-MGFS-DWVM4R-20260812091706

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197610286
Report Date: 07/21/2026
Date Signed: 07/21/2026 04:42:32 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

This is an official report of an unannounced visit/investigation of a complaint received in our office on
02/18/2026 and conducted by Evaluator Evelin Rios

COMPLAINT CONTROL NUMBER: 31-AS-20260218185246

FACILITY NAME:	PALM VISTA SENIOR LIVING		FACILITY NUMBER:	197610286
ADMINISTRATOR:	MONTALVO, STUART		FACILITY TYPE:	740
ADDRESS:	3850 WEST RANCHO VISTA BLVD		TELEPHONE:	(661) 202-3999
CITY:	PALMDALE	STATE: CA	ZIP CODE:	93551
CAPACITY:	115	CENSUS: 87	DATE:	07/21/2026
		UNANNOUNCED	TIME BEGAN:	02:30 PM
MET WITH:	Stuart Montalvo - Executive Director		TIME COMPLETED:	04:55 PM

ALLEGATION(S):

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Staff did not provide resident adequate care or supervision to prevent frequent falls resulting in hospitalization.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Evelin Rios and Licensing Program Manager (LPM) Mary Flores conducted an unannounced subsequent complaint visit regarding the above allegation.

The investigation consisted of the following:

On 02/24/26 LPA Rios conducted an initial complaint investigation and requested copies of the residents and staff rosters, copies of relevant documents for the investigation. LPA interviewed the Administrator, Resident Care Director, and two (2) staff, and conducted a physical plant tour of the facility. On 7/21/26 LPA and LPM conducted interviews with 8 residents and 8 staff.

(Continue to LIC9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Mary G Flores
LICENSING EVALUATOR NAME: Evelin Rios
LICENSING EVALUATOR SIGNATURE:	DATE: 07/21/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2026

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 31-AS-20260218185246

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS S.RO, 21731 VENTURA BLVD., STE. 250
WOODLAND HILLS, CA 91364

FACILITY NAME: PALM VISTA SENIOR LIVING	FACILITY NUMBER: 197610286
	VISIT DATE: 07/21/2026

NARRATIVE

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The investigation revealed the following:

Regarding allegation: Staff did not provide adequate resident care or supervision to prevent frequent falls which resulted in hospitalization. It is alleged a resident has fallen 3 times and one of the falls resulted in a head injury. Interviews with residents revealed 7 out of 8 residents stated staff are quick to respond when they have a fall, staff update their needs and care plan as needed, provide the necessary assistance as well as check on the residents more often after a fall occurs until there are no concerns. 1 out of 8 residents refused to be interviewed. Interviews with staff revealed upon observing a resident fall staff respond by going to the resident, informed the Med-Tech on duty, Medtech evaluates the resident, calls emergency respond services if necessary. When a resident has an open wound injury because of a fall or hit their head emergency responder services are called and the residents are sent out to the hospital. Documents reviewed revealed Resident #1(R1)’s physician’s report dated: 8/18/25 notes R1 has a non-ambulatory status and does not have any motor impairments. Incident report dated: 2/8/26 notes R1 was found on the floor in the patio laying in their back and blood was noted from the back of the head. The facility contacted emergency services and R1 was taken to the hospital. Needs and Care plan dated 8/21/25 notes no falls for R1. Needs and Care plan dated: 08/21/25 notes an update on 2/14/26 as R1 being a fall risk and requiring partial assist. Interventions are to monitor R1 and assist with compliance of use of mechanical aides. Needs and Care plan dated: 08/21/25 notes updates on 4/22/26 and 6/27/26 to redirect and provide safety education to R1. There were no incident reports prior 02/08/26 to note falls for R1. Although R1 sustained a fall that resulted in an injury based on documents reviewed there was no history of falls prior to that incident. Therefore, the allegation is unsubstantiated.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is UNSUBSTANTIATED.

Exit interview was conducted and a copy of this report was provided to the ED.

SUPERVISORS NAME: Mary G Flores
LICENSING EVALUATOR NAME: Evelin Rios
LICENSING EVALUATOR SIGNATURE:	DATE: 07/21/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2026

LIC9099 (FAS) - (06/04)

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