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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 331880572
Report Date: 06/22/2023
Date Signed: 06/22/2023 05:07:56 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, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/16/2022 and conducted by Evaluator Janira Arreola
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20220916114017
FACILITY NAME:PACIFIC VISTA SENIOR LIVINGFACILITY NUMBER:
331880572
ADMINISTRATOR:TENG, JAMIEFACILITY TYPE:
740
ADDRESS:17085 BIRCH HILL ROADTELEPHONE:
(951) 850-1088
CITY:RIVERSIDESTATE: CAZIP CODE:
92504
CAPACITY:6CENSUS: 5DATE:
06/22/2023
UNANNOUNCEDTIME BEGAN:
02:11 PM
MET WITH:Licensee, Jaime TengTIME COMPLETED:
05:15 PM
ALLEGATION(S):
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9
Staff cannot communicate with residents in home.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Janira Arreola, conducted an unannounced visit to the facility in order to investigate the above allegations. LPA met with Licensee, Jaime Teng who was informed of the purpose of the visit. During the investigation, LPA conducted interviews, documented observations, and conducted records reviews.

It was alleged that staff could not communicate with residents in the home and complete services for them due to limited english. LPA interviewed Four (4) facility residents. Three (3) of the resident interviewed reported being able to communicate with staff. These residents reported no issues with staff communication and services provided.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Joel EsquivelTELEPHONE: (951) 202-5067
LICENSING EVALUATOR NAME: Janira ArreolaTELEPHONE: 951-248-2222
LICENSING EVALUATOR SIGNATURE:

DATE: 06/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/22/2023
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 2
Control Number 18-AS-20220916114017
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507
FACILITY NAME: PACIFIC VISTA SENIOR LIVING
FACILITY NUMBER: 331880572
VISIT DATE: 06/22/2023
NARRATIVE
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One (1) resident was interviewed where it was found that they were unsatisfied with communication with staff, stating they had to repeat themselves serval times, provide clarification, and "yell" at staff when they reported not being able to hear the resident. The resident reported their services where completed. LPA interviewed the (3) staff identified in the complaint. All staff were able to be interviewed in English with LPA. All staff reported being able to communicate with the resident in English. Furthermore, LPA observed S1 and S2 communicating with a resident responsible about the care provided to the resident. LPA was provided with progress notes written b y S1, which were observed to be in English.

Therefore, based on observations and interviews, the allegation is unsubstantiated. A finding of unsubstantiated means that the preponderance of the evidence standard has not been met.

An exit interview was conducted with Licensee, Jaime Teng where this report was reviewed and provided to them.
SUPERVISOR'S NAME: Joel EsquivelTELEPHONE: (951) 202-5067
LICENSING EVALUATOR NAME: Janira ArreolaTELEPHONE: 951-248-2222
LICENSING EVALUATOR SIGNATURE:

DATE: 06/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/22/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2