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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374604134
Report Date: 10/26/2023
Date Signed: 10/26/2023 12:49:37 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
10/25/2023 and conducted by Evaluator Sara Martinez
COMPLAINT CONTROL NUMBER: 18-AS-20231025125859
FACILITY NAME:PACIFICA SENIOR LIVING VISTAFACILITY NUMBER:
374604134
ADMINISTRATOR:ENCISO, KARENFACILITY TYPE:
740
ADDRESS:760 EAST BOBIER DRIVETELEPHONE:
(760) 941-1480
CITY:VISTASTATE: CAZIP CODE:
92084
CAPACITY:252CENSUS: 33DATE:
10/26/2023
UNANNOUNCEDTIME BEGAN:
09:46 AM
MET WITH:Starsha Clark - Memory Care DirectorTIME COMPLETED:
12:57 PM
ALLEGATION(S):
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Staff do not ensure resident’s room is clean and sanitary
Resident’s room is malodorous
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Sara Martinez conducted an unannounced visit to the facility to initiate an investigation regarding the allegations listed above. LPA was granted entry and met with Memory Care Director Starsha Clark who was informed of the purpose for this visit. LPA toured the facility, reviewed records, conducted interviews, and took copies of pertinent information.

Regarding the allegation "Staff do not ensure resident’s room is clean and sanitary” and "Resident’s room is malodorous", LPA conducted interviews with staff, residents, and Resident One (R1) that does not corroborate with the allegations. LPA’s initial walkthrough of the facility was conducted and revealed room #406, #409, #411, #412, and #416 and their attached bathrooms to be clean and in good repair. LPA's observations during the tour of the facility revealed the residents’ rooms are clean and organized, no observable dirty clothes on any of the floors, and there were no strong orders of any kind present. (Continued on LIC 9099-C)
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Rikesha StampsTELEPHONE: (951) 212-0616
LICENSING EVALUATOR NAME: Sara MartinezTELEPHONE: (951) 248-0314
LICENSING EVALUATOR SIGNATURE:

DATE: 10/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/26/2023
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-20231025125859
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: PACIFICA SENIOR LIVING VISTA
FACILITY NUMBER: 374604134
VISIT DATE: 10/26/2023
NARRATIVE
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Additional feedback provided during interviews with staff and residents revealed that caregivers make the residents’ bed and clean the residents’ room daily. Based on observation and interviews, there is no concerns that would prove that the facility is dirty or malodorous thus the allegations are UNSUBSTANTIATED.

An allegation(s) finding of unsubstantiated means, although the allegations may have happened or are valid, there is not a preponderance of the evidence strand to prove the alleged violations did or did not occur.

An exit interview was conducted, and a copy of this report was provided to Starsha Clark.
SUPERVISOR'S NAME: Rikesha StampsTELEPHONE: (951) 212-0616
LICENSING EVALUATOR NAME: Sara MartinezTELEPHONE: (951) 248-0314
LICENSING EVALUATOR SIGNATURE:

DATE: 10/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/26/2023
LIC9099 (FAS) - (06/04)
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