306005984-2-3-2026-22-AS-AORZ-DR6TK5-20260210134721

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306005984
Report Date: 02/03/2026
Date Signed: 02/03/2026 04:46:03 PM

Substantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/14/2022 and conducted by Evaluator Fred Arias

COMPLAINT CONTROL NUMBER: 22-AS-20220714122113

FACILITY NAME:	CIELO VISTA SENIOR LIVING		FACILITY NUMBER:	306005984
ADMINISTRATOR:	LOMEDA, RONA D		FACILITY TYPE:	740
ADDRESS:	7571 WYOMING ST		TELEPHONE:	(562) 569-8914
CITY:	WESTMINSTER	STATE: CA	ZIP CODE:	92683
CAPACITY:	122	CENSUS: 24	DATE:	02/03/2026
		UNANNOUNCED	TIME BEGAN:	08:40 AM
MET WITH:	Virgil Agas		TIME COMPLETED:	05:00 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Facility staff did not follow hospice care plan for resident

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst (LPA) Fred Arias conducted an unannounced complaint visit to finalize an investigation into the above allegation. LPA was greeted and granted entry into the facility and explained the reason for the visit.

It was alleged facility staff did not follow hospice care plan for resident. During the investigation, LPA conducted interviews with staff and residents in care. LPA reviewed records obtained. The investigation determined as follows: Regarding the allegation facility staff did not follow hospice care plan for resident, it was reported Resident 1 (R1) was not being turned every two hours as indicated in the hospice plan. LPA interviews with one out of four staff stated they help turn residents who need assistance every two hours or as needed. One out of the remaining three staff stated they help transfer residents in and out of bed.The remaining two staff did not add anything relevant to this allegation. Interviews with three out of four residents stated their needs are being met and get assistance from staff for transfers.
Continued on LIC9099-C dated 02/03/2026

Substantiated

Estimated Days of Completion:

SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Fred Arias
LICENSING EVALUATOR SIGNATURE:	DATE: 02/03/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/03/2026

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 6

Control Number 22-AS-20220714122113

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: 02/03/2026

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

Three out of the four residents stated they do not need assistance with turning in their beds. The remaining resident stated they do not need assistance with transfers or turning in their bed. Record review for R1 revealed three out of three care staff received hospice care training on December 4, 2025. A hospice plan of care created on July 1, 2022 indicating R1's mobility plan including "...the need to turn patient every 2 hours..." R1's turning schedule from July 1, 2022 to July 10, 2022 did not indicate R1 was turned every 2 hours on July 3, 2022; July 4, 2022 and July 5, 2022. July 3, 2022 indicated R1 was turned at 12:00am, 2:00am, 4:00am, and 6:00am. July 4, 2022 indicated R1 was turned at 8:00am, 10:00am, 9:30pm, and 11:30pm. July 5, 2022 indicated R1 was turned at 1:30am, 3:30am, and 5:30am. No other times were indicated for those three dates. On July 7, 2022, R1 was indicated as turned with a three hour gap between 5:00am and 8:00am.

Based on interviews conducted and record review, the preponderance of evidence standard has been met. Therefore, the above allegation is found to be SUBSTANTIATED.

California Code of Regulations, (Title 22, Division 6), are being cited on the attached LIC 9099D.

An exit interview was conducted and a copy of the report was left with the facility representative along with appeal rights.

SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Fred Arias
LICENSING EVALUATOR SIGNATURE:	DATE: 02/03/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/03/2026

LIC9099 (FAS) - (06/04)

Page: 2 of 6

Control Number 22-AS-20220714122113

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 02/03/2026

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 02/17/2026 Section Cited CCR 78633(d)	1 2 3 4 5 6 7	78633(d) Hospice Care of Terminal Ill Residents The licensee shall ensure that the hospice care plan is current, accurately matches the services actually being provided, and that the client’s care needs are being met at all times.	1 2 3 4 5 6 7	AD stated specific training on repositioning resident and documenting times will be completed and submitted to LPA by POC due date.
	8 9 10 11 12 13 14	This requirement is not met as evidence by: R1's hospice plan for mobility was not followed accurately which poses a potential health and safety risk to persons in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Fred Arias
LICENSING EVALUATOR SIGNATURE:	DATE: 02/03/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/03/2026

LIC9099 (FAS) - (06/04)

Page: 3 of 6

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/14/2022 and conducted by Evaluator Fred Arias

COMPLAINT CONTROL NUMBER: 22-AS-20220714122113

FACILITY NAME:	CIELO VISTA SENIOR LIVING		FACILITY NUMBER:	306005984
ADMINISTRATOR:	LOMEDA, RONA D		FACILITY TYPE:	740
ADDRESS:	7571 WYOMING ST		TELEPHONE:	(562) 569-8914
CITY:	WESTMINSTER	STATE: CA	ZIP CODE:	92683
CAPACITY:	122	CENSUS: 24	DATE:	02/03/2026
		UNANNOUNCED	TIME BEGAN:	08:40 AM
MET WITH:	Virgil Agas		TIME COMPLETED:	05:00 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Facility failed to update responsible party of resident's status
Facility staff did not dispense medication as prescribed
Resident room is not kept clean
Facility is malodorous
Facility staff did not provide personal assistance with bathing of resident

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst (LPA) Fred Arias conducted an unannounced complaint visit to finalize an investigation into the above allegations. LPA was greeted and granted entry into the facility and explained the reason for the visit.

It was alleged facility failed to update responsible party of resident's status, facility staff did not dispense medication as prescirbed, resident room is not kept clean, facility is malodorous, and facility staff did not provide personal assistance with bathing of resident. During the investigation, LPA conducted interviews with staff and residents in care. LPA reviewed records obtained. The investigation determined as follows: Regarding the allegation facility failed to update responsible party of resident's status, it was reported Resident 1 (R1)'s family was not notified of R1's passing until four hours later. LPA inteviews with one out of four staff stated family is notified of any change of condition of the residents.Two out of the remaining three staff stated they will inform any change of condition to the on-duty med-tech and the management staff available. The remaining staff did not add anything relevant to the allegation. Continued on LIC9099-C dated 02/02/2026.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Fred Arias
LICENSING EVALUATOR SIGNATURE:	DATE: 02/03/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/03/2026

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

LIC9099 (FAS) - (06/04)

Page: 4 of 6

Control Number 22-AS-20220714122113

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: 02/03/2026

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

Record review revealed a representative from hospice was present at the facility on July 11, 2022, the same day of R1's passing. Regulation 87466 Observation of the Resident states the resident's physician and responsible party must be notified of a change of condition. It does not indicate a time requirement on when that notification must take place.

Regarding the allegation facility staff did not dispense medication as prescribed, it was reported facility did not assist in providing R1 with pain medication unless prompted by family. R1's physician report dated July 1, 2022 indicated R1 could not ingest by mouth "NPO". R1's appraisal and functional capabilities form indicated R1 was non-verbal. Hospice sign in sheet indicated hospice staff visited R1 on July 1, 2022; July 2, 2022; July 3, 2022, July 4, 2022; July 6, 2022; July 7, 2022, July 9,2022, July 10, 2022, and July 11, 2022. Progress notes for R1 dated July 7, 2022 indicated hospice nurse met with family and R1 at the facility regarding R1's condition. Since R1 was listed as NPO, hospice nurse requested a pain medication patch to be ordered through the hospice physician. Pain medication patch was delivered and administered later the same day. Pain medication patch was prescribed to provide 72 hours of pain relief. Progress note for July 10, 2022 indicated family wanted facility to provide morphine to R1. Facility staff contacted hospice for approval. Hospice approved and morphine was given to R1 on that day. LPA reviewed medication training for three current staff and was completed on December 1, 2025.

Regarding the allegation resident room was not clean, it was reported R1's room was dirty. LPA interviews with four out of four staff stated rooms are cleaned regularly. One out of four staff added each room is deep cleaned twice a week with quick cleanings done throughout the week. Four out of four residents stated their rooms are cleaned throughout the week. LPA observed floors were being mopped in the morning and did not observed any dirty areas in the facility including four rooms visited.

Regarding the allegation facility is malodorous, it was reported R1's room had a bad smell. LPA did not observe any bad odors at the facility. LPA interviews with four out of four staff stated there are no lingering bad odors at the facility. Interviews with three out of four residents stated there are no bad odors at the facility. The remaining resident did not add anything relevant to the allegation.

Regarding the allegation staff did not provide personal assistance with bathing of resident, it was reported R1 was bathed once in ten days while living at the facility. LPA interviews with two out of four staff stated each resident is assisted with showers two to three times per week. The remaining staff did not add anything relevant to the allegation.

SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Fred Arias
LICENSING EVALUATOR SIGNATURE:	DATE: 02/03/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/03/2026

LIC9099 (FAS) - (06/04)

Page: 5 of 6

Control Number 22-AS-20220714122113

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: 02/03/2026

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

LPA interviews with three out of four resident stated they receive assistance from staff with bathing. Two out of the three residents added they receive two showers per week. The remaining resident stated they returned to the facility two weeks ago and has not received assistance with a shower. LPA observed this resident to be well groomed and did not observed any odors.

Based on interviews, record review, and observations, the allegations are therefore deemed unsubstantiated meaning that although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violations occurred.

An exit interview was conducted and a copy of the report was left with the facility representative.

SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Fred Arias
LICENSING EVALUATOR SIGNATURE:	DATE: 02/03/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/03/2026

LIC9099 (FAS) - (06/04)

Page: 6 of 6