374604176-4-27-2025-08-AS-RORN-DGHP9N-20250509110722

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374604176
Report Date: 04/27/2025
Date Signed: 04/27/2025 10:12:17 AM

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
12/23/2021 and conducted by Evaluator Elvira Gonzalez

COMPLAINT CONTROL NUMBER: 08-AS-20211223102726

FACILITY NAME:	ALTA VISTA SENIOR LIVING		FACILITY NUMBER:	374604176
ADMINISTRATOR:	ALSPACH, DAVID		FACILITY TYPE:	740
ADDRESS:	2041 W VISTA WAY		TELEPHONE:	(760) 941-3233
CITY:	VISTA	STATE: CA	ZIP CODE:	92083
CAPACITY:	98	CENSUS: 78	DATE:	04/27/2025
		UNANNOUNCED	TIME BEGAN:	08:00 AM
MET WITH:	Activities Director, Destiny Quijada		TIME COMPLETED:	10:30 AM

ALLEGATION(S):

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Resident sustained unexplained injuries while in care.
Residents are left in soiled diapers for extended period of time.

INVESTIGATION FINDINGS:

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On 04/27/25, Licensing Program Analyst (LPA) Elvira Gonzalez conducted a subsequent unannounced visit to further investigate and deliver findings for the above-named allegations. LPA met with Activities Director, Destiny Quijada, and the purpose of the visit was discussed. LPA was granted access into the facility.

The investigation consisted of the following:
On 12/30/21, the department conducted a review of records and requested and obtained copies of pertinent documentation. On 04/26/25, the department conducted interviews with staff #1-#5 (S1-S5), and resident #1-#8 (R1-R8). The department requested and received the following documents: staff roster, and resident roster. Furthermore, the department conducted a tour of the facility.

Continued on LIC 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Elvira Gonzalez
LICENSING EVALUATOR SIGNATURE:	DATE: 04/27/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/27/2025

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 08-AS-20211223102726

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 SENIOR LIVING	FACILITY NUMBER: 374604176
	VISIT DATE: 04/27/2025

NARRATIVE

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The investigation revealed the following:

Allegation: Resident sustained unexplained injuries while in care. It is being alleged that a resident sustained some skin tears, possibly done when staff tried to reposition the resident. On 04/26/25, between 10:25 AM and 12:00 PM the department interviewed S1-S5. Based on interviews conducted, 5 out of 5 staff interviewed were not aware of the allegation. 5 out of 5 staff interviewed stated that all clients are treated with care, patience, dignity and respect.

On 04/26/25, between 01:10 PM and 02:40 PM, the department interviewed R1-R8. Based on interviews conducted, 8 out of 8 residents interviewed did not know of a resident sustaining unxexplained injuries while in care. 8 out of 8 residents interviewed stated that facility staff is providing them with the necessary care and supervision. 8 out of 8 residents interviewed stated that they are satisfied with the services being provided to them.

Based on interviews, a review of records, and observation, the above allegation is found to be 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.

Allegation: Residents are left in soiled diapers for extended period of time. It is being alleged that a resident was found drenched in urine and that they had not been checked on since the night before. On 04/26/25, between 10:25 AM and 12:00 PM, the department interviewed S1-S5. Based on interviews conducted, 5 out of 5 staff interviewed stated did not know of a resident being left in soiled diapers for an extended period of time. 4 out of 5 staff interviewed stated residents are changed every 4 hours and as needed, and 1 out of 5 staff interviewed stated they did not know how often residents were changed.

On 04/26/25, between 01:10 PM and 02:40 PM, the department interviewed R1-R8. Based on interviews conducted, 7 out of 8 residents interviewed stated they did not know of a resident being left in a soiled diaper for an extended period of time, and 1 out of 8 residents stated they have been left in a soiled diaper for an extended period of time.

Continued on LIC 9099-C

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Elvira Gonzalez
LICENSING EVALUATOR SIGNATURE:	DATE: 04/27/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/27/2025

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 08-AS-20211223102726

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 SENIOR LIVING	FACILITY NUMBER: 374604176
	VISIT DATE: 04/27/2025

NARRATIVE

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7 out of 8 residents interviewed stated that they are changed when they need to be changed, and 1 out of 8 residents interviewed stated they are not changed when they need to be changed. 7 out of 8 residents interviewed stated that their daily needs are being met, and 1 out of 8 residents interviewed stated that their daily needs are sometimes met. 8 out of 8 residents interviewed stated that they are satisfied with the services being provided to them.

Based on interviews, file review and observation, the above allegation is found to be 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.

No deficiencies were cited during this visit.

An exit interview was conducted with Activities Director, Destiny Quijada, and a copy of this report was provided.

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Elvira Gonzalez
LICENSING EVALUATOR SIGNATURE:	DATE: 04/27/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/27/2025

LIC9099 (FAS) - (06/04)

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