374601228-5-13-2026-18-AS-RLAY-DUAVMQ-20260521163353

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374601228
Report Date: 05/13/2026
Date Signed: 05/13/2026 01:22:14 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 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
01/05/2026 and conducted by Evaluator Jacqueline Shaw Ross

COMPLAINT CONTROL NUMBER: 18-AS-20260105132727

FACILITY NAME:	ALTA VISTA MANOR		FACILITY NUMBER:	374601228
ADMINISTRATOR:	ANNA WILSON		FACILITY TYPE:	740
ADDRESS:	625 MARAZON LANE		TELEPHONE:	(760) 295-0506
CITY:	VISTA	STATE: CA	ZIP CODE:	92083
CAPACITY:	15	CENSUS: 11	DATE:	05/13/2026
		UNANNOUNCED	TIME BEGAN:	09:50 AM
MET WITH:	Anna Wilson, Administrator		TIME COMPLETED:	01:25 PM

ALLEGATION(S):

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Licensee is not adhering to resident's admission agreement.
Staff mismanaged resident's medication.

INVESTIGATION FINDINGS:

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On 05/13/2026, Licensing Program Analyst (LPA) Jacqueline Shaw-Ross arrived unannounced at the facility to deliver findings of the investigation regarding the allegations listed above. The LPA met with Administrator, Anna Wilson, and informed her of the purpose of her visit.

The investigation included staff interviews, a review of records, and collection of relevant documentation.

It was alleged that the family of R1 believed they would not receive a partial refund following R1's passing on 12/26/2025. The family had paid in advance for the period of 12/5/2025, through 01/05/2026, and believed they were entitled to a refund for the remaining nine days. A review of R1's Admission Agreement was conducted and indicated that "Any refund of fees paid in advance for the time following the resident's death would be issued within 15 days after all of the resident's personal belonging had been removed from the facility."

Continued LIC 9099-C....

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Rikesha Stamps
LICENSING EVALUATOR NAME: Jacqueline Shaw Ross
LICENSING EVALUATOR SIGNATURE:	DATE: 05/13/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/13/2026

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 18-AS-20260105132727

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
RIVERSIDE ASC, 1650 SPRUCE ST STE 200 MS29-27
RIVERSIDE, CA 92507

FACILITY NAME: ALTA VISTA MANOR	FACILITY NUMBER: 374601228
	VISIT DATE: 05/13/2026

NARRATIVE

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A review documents and interviews conducted with staff revealed that the family of R1 was issued a check for the appropriate refund amount, which covered the remaining nine days following R1's passing. The family of R1 became upset when the administrator attempted to assess an additional charge for painting the bedroom walls. However, no additional fees were ultimately charged for normal wear and tear. Therefore the allegation that the Licensee is not adhering to the resident's Admission Agreement is unsubstantiated.

It was alleged that staff mismanaged R1's medication by failing to administer morphine to the resident. Interviews conducted with staff and a review of obtained documents revealed that R1 had a physician's order for morphine to be administered on an as-needed basis for pain and shortness of breath. Additionally, an interview with R1's family indicated there were no concerns regarding the administration of medication to the resident. Therefore the allegation that staff mismanaged R1's medication is unsubstantiated.

A finding that the complaint is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove the alleged violations occurred.

An exit interview was conducted and a copy of this report, and appeal rights were provided to Anna Wilson.

SUPERVISORS NAME: Rikesha Stamps
LICENSING EVALUATOR NAME: Jacqueline Shaw Ross
LICENSING EVALUATOR SIGNATURE:	DATE: 05/13/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/13/2026

LIC9099 (FAS) - (06/04)

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