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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374604176
Report Date: 04/27/2025
Date Signed: 04/27/2025 12:23:14 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
09/19/2024 and conducted by Evaluator Sandra Urena
COMPLAINT CONTROL NUMBER: 18-AS-20240919115403
FACILITY NAME:ALTA VISTA SENIOR LIVINGFACILITY NUMBER:
374604176
ADMINISTRATOR:ALSPACH, DAVIDFACILITY TYPE:
740
ADDRESS:2041 W VISTA WAYTELEPHONE:
(760) 941-3233
CITY:VISTASTATE: CAZIP CODE:
92083
CAPACITY:98CENSUS: DATE:
04/27/2025
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Destiny QuijadaTIME COMPLETED:
12:30 PM
ALLEGATION(S):
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Staff did not keep facility free of insects.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Sandra Urena conducted a subsequent visit to continue to investigate the allegation listed above, and to deliver the findings. The LPA arrived at the facility and spoke with Destiny Quijada, Activities Director (AD). The LPA explained the reason for the visit.

On 09/24/2024, Licensing Program Analyst (LPA), Javina George, conducted an unannounced visit to the facility to initiate the investigation into the allegation listed above. LPA met with Executive Director Jennifer Gephart and informed her of the purpose of LPAs visit. LPA conducted a tour of the interior/exterior areas of the facility, conducted a review of records, obtained and requested copies of pertinent documentation. On 04/26/2025, LPA Sandra Urena interviewed staff, and residents and obtained copies of pertinent documents relevant to the investigation, and conducted a tour of the facility at 1:15 p.m.

Continues on LIC 9099C...
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Kasandra LopezTELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Sandra UrenaTELEPHONE: 747-230-3919
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)
Page: 1 of 6
Control Number 18-AS-20240919115403
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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Staff did not keep facility free of insects.
On the allegation that staff did not keep facility free of insects, it is the concern of the Reporting Party (RP) that the facility is doing nothing about the bed bug issue and believes it has been a problem for months. On 09/19/2024, LPA George conducted an interview with the RP who stated that R1 sits in their bedroom chair and picks off the bugs off their arms. Furthermore, LPA George conducted a facility visit on 09/24/2024 and was unable to inspect the rooms due to not having access to the rooms due to being treated for bed bugs.
On 04/26/2025, LPA Urena interviewed the Resident Services Director (RSD) about the bug infestation. The interview revealed that the facility did experience a bug infestation problem in September of 2024. The infestation was taken care as follows: By relocating the residents to vacant rooms, removing residents’ clothes and linens (bagging the clothes and linens, treating them with heat, then washing them), and treating the rooms with heat for 48 eight hours followed by spraying the rooms with bug spray. The rooms were aired out for at least 24 hours before residents were allowed to return. Record review of at least two exterminator and pest control companies’ invoices revealed that the facility has kept up with monthly pest control services to prevent re-infestation. Residents’ interviews revealed that they have not experienced bug problems since last year when the rooms were treated. Staff interviews revealed that they were aware of the bug infestation. LPA Urena was unable to interview R1.

Based on the information obtained through interviews, observation and record review, the allegation that staff did not keep the facility free of insects was confirmed. Therefore, the allegation is deemed Substantiated at this time.

Pursuant to the California Code of Regulations, Title 22, Division 6, Chapter 6, the following deficiencies were observed and cited (9099-D) during the visit.

Citations were issued. Exit Interview was conducted. A copy of the report and Appeal Rights were issued.
SUPERVISOR'S NAME: Kasandra LopezTELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Sandra UrenaTELEPHONE: 747-230-3919
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 6
Control Number 18-AS-20240919115403
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/27/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/02/2025
Section Cited
CCR
87303(a)
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CCR 87303(a) Maintenance and Operation - The facility shall be clean, safe, sanitary and in good repair at all times...safety and well-being of residents, employees and visitors. This requirement is not met as evidenced by.
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POC: The Administrator agreed to review section cited and provide a statement of understanding on how ensure that the facility will be kept free of pest to LPA Urena via email by 05/02/2025.The Licensee contracted a fumigation exterminator company, and the bug infestation was cleared.
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Based on interviews and records review, the licensee failed to comply with the section cited above as bed bugs were observed by multiple residents in multiple bedrooms, which poses a potential health and personal rights risk to persons in care.
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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: Kasandra LopezTELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Sandra UrenaTELEPHONE: 747-230-3919
LICENSING EVALUATOR SIGNATURE:

DATE: 04/27/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/27/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 6
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
09/19/2024 and conducted by Evaluator Sandra Urena
COMPLAINT CONTROL NUMBER: 18-AS-20240919115403

FACILITY NAME:ALTA VISTA SENIOR LIVINGFACILITY NUMBER:
374604176
ADMINISTRATOR:ALSPACH, DAVIDFACILITY TYPE:
740
ADDRESS:2041 W VISTA WAYTELEPHONE:
(760) 941-3233
CITY:VISTASTATE: CAZIP CODE:
92083
CAPACITY:98CENSUS: DATE:
04/27/2025
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Destiny QuijadaTIME COMPLETED:
12:30 PM
ALLEGATION(S):
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Staff did not safeguard resident's personal belongings.
Staff are not bathing a resident in care.

INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Sandra Urena conducted a subsequent visit to continue to investigate the allegations listed above, and to deliver the findings. The LPA arrived at the facility and spoke with Destiny Quijada, Activities Director (AD). The LPA explained the reason for the visit.

On 09/24/2024, Licensing Program Analyst (LPA), Javina George, conducted an unannounced visit to the facility to initiate the investigation into the allegations listed above. LPA met with Executive Director Jennifer Gephart and informed her of the purpose of LPAs visit. LPA conducted a tour of the interior/exterior areas of the facility, conducted a review of records, obtained and requested copies of pertinent documentation. On 04/26/2025, LPA Sandra Urena interviewed staff, and residents and obtained copies of pertinent documents relevant to the investigation, and conducted a tour of the facility at 1:15 p.m.

Conitnues on LIC 9099C...
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Kasandra LopezTELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Sandra UrenaTELEPHONE: 747-230-3919
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)
Page: 4 of 6
Control Number 18-AS-20240919115403
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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Staff did not safeguard resident's personal belongings.
On the allegation that the staff do not safeguard resident’s personal belongings, it is the concern of the Reporting Party (RP) that some R1’s articles of clothing are missing, per the RP, only one item of clothing was identified by R1, and was unable to identify any additional items. To investigate the allegation, LPA Urena conducted staff and residents’ interviews. The residents’ interviews revealed that they have not experienced personal belongings missing from their room. The residents stated that if they leave any items in the clothing pockets (e.g. reading glasses) when the clothes get taken to get washed, staff always return the items. The staff interviews revealed that sometimes residents may forget personal belongings when they are in common areas of the facility, if the staff notices right away and know who the item belongs to, they rerun the item to the resident, if not, they give it to the med tech. The LPA interviewed the housekeeping and laundry staff and asked if residents’ clothing could be getting misplaced during the wash and not returned to the original resident. The housekeeping staff and laundry staff stated that the laundry (clothes and linens) get collected from each of the residents’ room in a laundry basket. The clothes and linens are then washed individually per resident. Residents’ clothes are never mixed in the wash and dry cycle. The staff puts the residents’ clothes and linens back in the hamper and return it to the residents’ rooms. When asked if they were aware that residents were alleging that articles of clothing were missing, they said they were not aware. Facility was not able to locate R1’s Client /Resident Personal Property and Valuables(LIC 621). LPA Urena was unable to interview R1.

Based on the information obtained through interviews and record review, and although the allegation may be valid, and may have happened, there is not sufficient evidence to confirm if the personal belongings are not being safeguarded by staff. Therefore, the allegation is deemed Unsubstantiated at this time.
SUPERVISOR'S NAME: Kasandra LopezTELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Sandra UrenaTELEPHONE: 747-230-3919
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: 5 of 6
Control Number 18-AS-20240919115403
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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Pg. 3
Staff are not bathing a resident in care.
On the allegation that the staff are not bathing a resident in care, it is the concern of the Reporting Party (RP) that R1 is not getting showers 2 times a week. To investigate the allegation, LPA Urena interviewed staff, residents in care and reviewed pertinent records. The residents’ interviews revealed that they do receive assistance with showers as needed, and at least two times a week, or more if requested or needed. Showers can be either in the a.m. (usually after breakfast or lunch) and/or in the p.m. shift after 2:00 p.m. The interview with the RSD revealed that the residents’ families can choose during the initial admission/registration process the preferred time frame (AM/PM) for a shower. Furthermore, the residents, and families can request additional bathing times if needed. The RSD stated that R1 was receiving assistance with showers. The interview with staff revealed that the staff make notations in the facility’s End of Shift Report (ESR) where staff document if the residents refuse a shower, reason for refusal and if resident had a shower. LPA Urena reviewed the ESR for 09/22024. The record review revealed that the ESR is a document that includes the names of the staff who provide the showers, names of residents, residents’ room number, an area for comments, etc. The record review indicated that R1 was being assisted with showers, and at least in two occasions R1 refused showers. Review of the Physician’s Report and the resident’s Assessment indicate that R1 did not need assistance with bathing. The LPA was unable to interview R1.

Based on the information obtained through interviews and record review, the staff was assisting R1 with showers, and R1 did not need assistance with bathing. Therefore, the allegation is deemed Unsubstantiated at this time.

Exit interview was conducted. A copy of the report was issued.
SUPERVISOR'S NAME: Kasandra LopezTELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Sandra UrenaTELEPHONE: 747-230-3919
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: 6 of 6