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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374604134
Report Date: 03/29/2025
Date Signed: 03/29/2025 05:14:44 PM

Substantiated


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
01/23/2024 and conducted by Evaluator Socorro Leandro
COMPLAINT CONTROL NUMBER: 18-AS-20240123120244
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:172CENSUS: 86DATE:
03/29/2025
UNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Sales Director - Alma ChavezTIME COMPLETED:
05:20 PM
ALLEGATION(S):
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Insufficient staff resulting in staff not checking on residents
INVESTIGATION FINDINGS:
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On 03/29/2025, the California Department of Social Services (CDSS) Community Care Community Care Licensing (CCL) Licensing Program Analyst (LPA) Socorro Leandro conducted an initial unannounced complaint visit. LPA Leandro met with Sales Director, Alma Chavez and the purpose of the visit was explained. LPA was granted entry to the facility.

The investigation consisted of the following:

On 01/30/2024, a facility tour was conducted. On 03/29/2025, a facility tour was conducted, records were reviewed, and interviews were conducted. The facility tour consisted of 8 resident rooms. Interviews conducted consisted of 7 staff interviews [Staff (S1) to Staff 7 (S7) were interviewed] and 8 resident interviews (R1 to R8 were interviewed). Facility records reviewed consisted of Rancho Vista Senior Living Census 2025 and Staff Schedule for February 2025, March 2025, and April 2025.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Ulysses CoronelTELEPHONE: (323) 400-7397
LICENSING EVALUATOR NAME: Socorro LeandroTELEPHONE: (916) 605-6831
LICENSING EVALUATOR SIGNATURE:

DATE: 03/28/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/28/2025
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 5
Control Number 18-AS-20240123120244
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: 03/29/2025
NARRATIVE
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The investigation revealed the following:

Allegation: “Insufficient staff resulting in staff not checking on residents”, it is being alleged that caregivers are not checking in on residents during pm shift and overnight hours. Interviews conducted with R1 to R8 revealed the following: 8 out of 8 residents disagree with the allegation. Interviews conducted with S1 to S7 revealed the following: 4 out of 3 staff agreed with the allegation. Records reviewed revealed the following: Upon review of the Staff Schedule from February to April 2025 for the PM shift that starts from 2:30 PM to 10:30 PM it depicts that 2 caregivers and 1 medical technician are on shift but through close review of documents LPA Leandro observed that only 1 caregiver and 1 medical technician were on shift. Upon review of the Staff Schedule for the months of February 2025 to April 2025 for the NOC shift starts from 10:30 PM to 6:30 AM it depicts that 1 caregiver and 1 medical technician are on shift, however through close review of the documents, LPA Leandro observed that for 8 days in the month of February 2025 there was only 1 staff were on shift and for the month of April 2025 there are 4 days were only 1 staff is scheduled and there are 4 days were there are no staff scheduled. Records review of the Rancho Vista Senior Living Census 2025 in the Assisted Living Unit demonstrates that there are 41 residents in that unit. Interviews conducted with staff indicated that from the 41 residents there are 10 residents who require incontinence care.Substantiated: Based on LPAs interviews and record reviews, 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 and Chapter 8 are being cited on the attached LIC 9099D.

An exit interview was conducted, a copy of this report was left with the Sales Director, Alma Chavez along with their appeal rights.
SUPERVISOR'S NAME: Ulysses CoronelTELEPHONE: (323) 400-7397
LICENSING EVALUATOR NAME: Socorro LeandroTELEPHONE: (916) 605-6831
LICENSING EVALUATOR SIGNATURE:

DATE: 03/29/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/29/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 5
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
01/23/2024 and conducted by Evaluator Socorro Leandro
COMPLAINT CONTROL NUMBER: 18-AS-20240123120244

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:172CENSUS: 86DATE:
03/29/2025
UNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Sales Director - Alma ChavezTIME COMPLETED:
05:20 PM
ALLEGATION(S):
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Staff do not treat residents with respect
INVESTIGATION FINDINGS:
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On 03/29/2025, the California Department of Social Services (CDSS) Community Care Community Care Licensing (CCL) Licensing Program Analyst (LPA) Socorro Leandro conducted an initial unannounced complaint visit. LPA Leandro met with Sales Director, Alma Chavez and the purpose of the visit was explained. LPA was granted entry to the facility.

The investigation consisted of the following:

On 01/30/2024, a facility tour was conducted. On 03/29/2025, a facility tour was conducted, records were reviewed, and interviews were conducted. The facility tour consisted of 8 resident rooms. Interviews conducted consisted of 7 staff interviews [Staff (S1) to Staff 7 (S7) were interviewed] and 8 resident interviews (R1 to R8 were interviewed). Facility records reviewed consisted of Rancho Vista Senior Living Census 2025 and Staff Schedule for February 2025, March 2025, and April 2025.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Ulysses CoronelTELEPHONE: (323) 400-7397
LICENSING EVALUATOR NAME: Socorro LeandroTELEPHONE: (916) 605-6831
LICENSING EVALUATOR SIGNATURE:

DATE: 03/29/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/29/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 18-AS-20240123120244
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: 03/29/2025
NARRATIVE
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The investigation revealed the following:

Allegation: “Staff do not treat residents with respect”, it is being alleged that staff do not treat residents with dignity and respect. Interviews conducted with R1 to R8 revealed the following: 8 out of 8 residents denied the allegation. Interviews conducted with S1 to S7 revealed the following: 6 out of 7 staff denied the allegation. Observations on 1/30/2024 and 3/29/2025 revealed the following: staff/caregivers were observed treating residents with dignity and respect. Based on interviews and observations this allegation is unsubstantiated. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated.

An exit interview was conducted, and a copy of this report was left with the Sales Director, Alma Chavez.
SUPERVISOR'S NAME: Ulysses CoronelTELEPHONE: (323) 400-7397
LICENSING EVALUATOR NAME: Socorro LeandroTELEPHONE: (916) 605-6831
LICENSING EVALUATOR SIGNATURE:

DATE: 03/29/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/29/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 18-AS-20240123120244
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/29/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/08/2025
Section Cited
CCR
87411(a)
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Personnel Requirements (a) Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs. In facilities licensed for sixteen or more, sufficient support staff shall be employed to ensure provision of personal assistance and care as required in Section 87608, Postural Supports. Additional staff shall be employed as necessary to perform office work, cooking, house cleaning, laundering, and maintenance of buildings, equipment and grounds. The licensing agency may require any facility to provide additional staff whenever it determines through documentation that the needs of the particular residents, the extent of services provided, or the physical arrangements of the facility require such additional staff for the provision of adequate services.

This requirement was not met as evidenced by:
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The Sales Director agreed to come up with a plan with her Administrator to increase the PM and NOC shift personnel.


Email documents below to CCLD as Proof of Correction.
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Based on records and interviews the licensee did not comply with the section cited above. 4 out of 7 staff agreed with allegation and records reviewed indicated that the facility at times has 1 staff for 41 residents and 10 of those residents require incontinence care. This is a potential health and safety risk to residents in care.
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Plan to increase PM and NOC shift staff
Plan to meet the requirements for CCR87411(a)
Personnel Record LIC500

Proof of Correction will be emialed to Socorro.Leandro@dss.ca.gov
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Ulysses CoronelTELEPHONE: (323) 400-7397
LICENSING EVALUATOR NAME: Socorro LeandroTELEPHONE: (916) 605-6831
LICENSING EVALUATOR SIGNATURE:

DATE: 03/29/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/29/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 5