374601228-1-28-2025-18-AS-RSTS-DDEN2J-20250130090446

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374601228
Report Date: 01/28/2025
Date Signed: 01/28/2025 01:24:41 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
06/08/2022 and conducted by Evaluator Stephanie Martinez

PUBLIC

COMPLAINT CONTROL NUMBER: 18-AS-20220608160358

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: 10	DATE:	01/28/2025
		UNANNOUNCED	TIME BEGAN:	10:45 AM
MET WITH:	Anna Wilson, Administrator		TIME COMPLETED:	01:35 PM

ALLEGATION(S):

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Staff refused to provide medical records to resident’s authorized representative.
Staff took possession of resident's personal property.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA), Stephanie Martinez, conducted an unannounced visit to the facility to deliver the findings of the investigation into the above allegations. The LPA met with Administrator, Anna Wilson, and informed her of the purpose of her visit.

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

A report was received alleging a representative of Resident One (R1) made several requests to receive medical records for the resident; however, the request was not fulfilled by the facility. Administrator Wilson was interviewed and denied the allegation. She reported there was no request received for copies of R1's records. She also reported the facility was not in possession of any of R1's medical records. A copy of email correspondence, dated 01/09/2022, was obtained which revealed a discussion between the facility Licensee, John Wilson, and an individual identified as a family member of R1. The correspondence was regarding the

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Rikesha Stamps	TELEPHONE: (951) -212-0616
LICENSING EVALUATOR NAME: Stephanie Martinez	TELEPHONE: (951) 204-5924
LICENSING EVALUATOR SIGNATURE:	DATE: 01/28/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/28/2025

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-20220608160358

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: 01/28/2025

NARRATIVE

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pending delivery of R1's records to the family member by the Licensee. The correspondence, however, did not provide confirmation of the request being satisfied. Licensee Wilson was not available to be interviewed. Administrator Wilson reported having no knowledge of the request for records and had no knowledge of whether the request was satisfied by the Licensee or not. R1 was not available to be interviewed, as the resident passed away on 01/02/2022, prior to the receipt of the allegation. R1's resident file was not available for review prior to the completion of the investigation. Staff and resident interviews could provide no information regarding the allegation. Therefore, due to a lack of information that could either refute or corroborate the allegation, this complaint is deemed UNSUBSTANTIATED at this time.

Another allegation was received alleging Administrator Wilson and Licensee Wilson stole R1's personal belongings from the resident's house after their death on 01/02/2022 and were attempting to take possession of R1's home title. Administrator Wilson was interviewed and denied having any of R1's personal property. Administrator Wilson did report she and Licensee, John Wilson, did ask the resident to sell their home to them for a price of $900,000.00 after the resident voluntarily discharged from the facility, sometime in 2018. According to Administrator Wilson, R1 refused to sell their home to either herself or Licensee Wilson. Licensee Wilson was not available to be interviewed. R1 was not available to be interviewed due to their passing on 01/02/2022, prior to the receipt of the allegation. R1's resident file was not available for review; however, Administrator Wilson was able to provide the LPA with an Admission Agreement showing R1 was admitted to the facility on 06/24/2017. Staff and resident interviews could provide no information regarding the allegation. Interviews were attempted with the authorized representatives of R1. One of two parties to respond reported having knowledge of alleged reports made by Administrator Wilson that R1 offered to sell their property to the staff members. The representative reported R1's property had not been sold to either the Administrator or the Licensee, though both parties were in pursuit of taking control of the resident's property via lawsuit. No documentation or other information was available to reveal when R1 left the facility or what the resident's medical diagnoses were at the time of admission. Therefore, due to a lack of information that could either refute or corroborate the allegation, this complaint is deemed UNSUBSTANTIATED at this time.

A finding 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.

This report was reviewed with Administrator Wilson and a copy was provided.

SUPERVISOR'S NAME: Rikesha Stamps	TELEPHONE: (951) -212-0616
LICENSING EVALUATOR NAME: Stephanie Martinez	TELEPHONE: (951) 204-5924
LICENSING EVALUATOR SIGNATURE:	DATE: 01/28/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/28/2025

LIC9099 (FAS) - (06/04)

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