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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005984
Report Date: 07/03/2026
Date Signed: 07/03/2026 04:56:35 PM

Document Has Been Signed on 07/03/2026 04:56 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:CIELO VISTA SENIOR LIVINGFACILITY NUMBER:
306005984
ADMINISTRATOR/
DIRECTOR:		VIRGILIO AGASFACILITY TYPE:
740
ADDRESS:7571 WYOMING STTELEPHONE:
(562) 569-8914
CITY:WESTMINSTERSTATE: CAZIP CODE:
92683
CAPACITY: 122CENSUS: 35DATE:
07/03/2026
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:00 PM
MET WITH:Rona Lomeda, Justin LeeTIME VISIT/
INSPECTION COMPLETED:
03:00 PM
NARRATIVE
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Licensing Program Analyst (LPA) Michael Tea conducted an unannounced Case Management visit to the facility. LPA met with Licensee (LE) Rona Lomeda and House Manager (HM) Justin Lee and explained the purpose of the visit.

The purpose of today's visit was to address concerns regarding the facility's management structure and oversight responsibilities. During the Department's review, information was obtained indicating that the current Administrator was reporting to Justin Lee, an associate of Dr. Kang, rather than to the current Licensee, Rona Lomeda. The Department also obtained information from LE Lomeda that she was no longer exercising effective control over the day-to-day operation of the facility despite remaining the licensed individual responsible for the facility. LE Lomeda stated that the Administrator was not following her direction or instructions and instead reported to Justin Lee.

The department discussed the matter with LE Lomeda and HM Lee and advised that, regardless of any ownership changes reflected in filings with the California Secretary of State, the Department recognizes the individual identified on the current facility license as the responsible Licensee until a new application has been approved and a new license has been issued. LPA reminded LE Lomeda that she must maintain control over the operation of the facility and that the Administrator is required to report directly to the current Licensee.

Based on information obtained during the Department's investigation, the following deficiencies are being cited:

· Title 22, Section 87405(b) – Administrator Qualifications and Duties, for the Administrator's failure to report to and keep the current Licensee informed regarding the operation of the facility.

(Case Management Report continued on LIC809C)

NAME OF LICENSING PROGRAM MANAGER: Lourdes Montoya
NAME OF LICENSING PROGRAM ANALYST: Michael Tea
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 07/03/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/03/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 4
California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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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
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: CIELO VISTA SENIOR LIVING
FACILITY NUMBER: 306005984
VISIT DATE: 07/03/2026
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· Title 22, Section 87205(a) – Accountability of Licensee Governing Body, for the Licensee's failure to maintain responsibility for and provide adequate oversight of the operation of the licensed facility.

The Department has advised LE Lomeda and HM Lee that if ownership of the facility has changed, a new application must be submitted to and approved by the Department before operational control may be transferred. Until such approval is granted, LE Lomeda remains the legally responsible Licensee and is responsible for ensuring the facility operates in compliance with applicable laws and regulations.

An exit interview was conducted with Licensee Rona Lomeda and House Manager Justin Lee. A copy of this report LIC809 and LIC 809C, LIC 809D and Appeal Rights were provided during the visit.

NAME OF LICENSING PROGRAM MANAGER: Lourdes Montoya
NAME OF LICENSING PROGRAM ANALYST: Michael Tea
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 07/03/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/03/2026
LIC809 (FAS) - (06/04)
Page: 3 of 4
Document Has Been Signed on 07/03/2026 04:56 PM - It Cannot Be Edited

Citations on this Visit Report are Under Appeal!


Created By: Michael Tea On 07/03/2026 at 02:48 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: CIELO VISTA SENIOR LIVING
FACILITY NUMBER: 306005984

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/03/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Under Appeal
Type B
07/24/2026
Section Cited
CCR
87405(b)

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Administrator Qualifications and Duties ...The administrator of a facility or facilities shall have the responsibility and authority to carry out the policies of the licensee. This requirement was not met as evidenced by:
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Licensee shall submit a signed statement acknowledging an understanding of the cited regulation and provide a written organizational chart identifying the facility's chain of command, including reporting relationships and the responsibilities of each staff position by POC due date to LPA.
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The Department determined that the Administrator was reporting to Justin Lee, an associate new prospective Licensee, rather than to the current Licensee, Rona Lomeda.This poses as a potential health and safety risk to residents in care.
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Type B
07/24/2026
Section Cited
CCR87205(a)

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Accountability of Licensee Governing Body ...The licensee, whether an individual or other entity, shall exercise general supervision over the affairs of the licensed facility and establish policies concerning its operation in conformance with these regulations and the welfare of the individuals it serves. This requirement was not met as evidenced by:
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Licensee shall submit a signed statement acknowledging an understanding of the cited regulation and conduct an in-service training with all current staff regarding the authority of the current Licensee and the facility's reporting structure. Documentation of the completed training, including staff signatures, shall be submitted to LPA by POC due date.
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The current Licensee acknowledged that she was no longer exercising effective oversight of the facility's day-to-day operations and stated that the Administrator was reporting to Justin Lee rather than to her. This poses as a potential health and safety risk to 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.
Lourdes Montoya
NAME OF LICENSING PROGRAM MANAGER:
Michael Tea
NAME OF LICENSING PROGRAM ANALYST:
LICENSING PROGRAM ANALYST SIGNATURE:
DATE: 07/03/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/03/2026


LIC809 (FAS) - (06/04)
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