<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 275202817
Report Date: 12/05/2024
Date Signed: 12/15/2024 09:00:23 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
FRESNO ASC, 1314 E SHAW AVE
FRESNO, CA 93710
This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/25/2024 and conducted by Evaluator Sarah Hurt
COMPLAINT CONTROL NUMBER: 24-AS-20240725145545
FACILITY NAME:VISTA HARDEN RANCHFACILITY NUMBER:
275202817
ADMINISTRATOR:CARTER, JOYFACILITY TYPE:
740
ADDRESS:290 REGENCY CIRCLETELEPHONE:
(805) 319-7370
CITY:SALINASSTATE: CAZIP CODE:
93906
CAPACITY:83CENSUS: 68DATE:
12/05/2024
UNANNOUNCEDTIME BEGAN:
05:30 PM
MET WITH:Executive Director, Maria PerezTIME COMPLETED:
06:45 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Due to neglect, resident sustained stage 4 pressure ulcers.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Sarah Hurt conducted an unannounced facility visit to deliver findings on the allegations listed above . LPA met with facility Administrator, Maria Perez and explained the purpose of today's visit.

Regaring the allegation Due to neglect, resident sustained stage 4 pressure ulcers. Resident 1's Progress Notes document on 07/14/2024 redness and open sore on bottom. Resident 1 was re assesed by the facility nurse on 07/14/2024. Resident 1's Progress Notes document they were to be admitted to home health .Resident 1 was seen by Home health staff on 07/17/2024 and sent to the local emergency room. Resident 1's was admitted to the emergency room on 07/17/2024 with a stage 4 sacrococcyged wound. Based on documents reviewed the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED.

The following deficiencies are being cited Per Title 22 Regulations.

Exit interview conducted with Executive Director Maria Perez, and a copy of this report along with appeals rights provided.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Brenda Chan
LICENSING EVALUATOR NAME: Sarah Hurt
LICENSING EVALUATOR SIGNATURE:

DATE: 12/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/05/2024
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 24-AS-20240725145545
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
FRESNO ASC, 1314 E SHAW AVE
FRESNO, CA 93710

FACILITY NAME: VISTA HARDEN RANCH
FACILITY NUMBER: 275202817
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/05/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
12/06/2024
Section Cited
CCR
87465(a)(1)
1
2
3
4
5
6
7
87465 Incidental Medical and Dental Care (a) A plan for incidental medical and dental care shall be developed by each facility. The plan shall encourage routine medical and dental care and provide for assistance in obtaining such care, by compliance with the following: (1) The licensee shall arrange, or assist in arranging, for medical and dental care appropriate to the conditions and needs of residents. The following requirement has not been met as evidenced by:
1
2
3
4
5
6
7
Executive Director will conduct training with facility staff on timely care and submit proof to LPA by POC date of 12/06/2024.
8
9
10
11
12
13
14
Based on records review, facility staff observed wound on resident 1 on 07/14/24, and resident 1 was admitted to hospital with stage 4 wound on 07/17/24, which poses an immediate health, safety, or personal rights risk to residents in care.
8
9
10
11
12
13
14
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Brenda Chan
LICENSING EVALUATOR NAME: Sarah Hurt
LICENSING EVALUATOR SIGNATURE:

DATE: 12/05/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/05/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2