331880572-3-11-2026-18-AS-JDHS-DS5VRZ-20260313164042

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 331880572
Report Date: 03/11/2026
Date Signed: 03/11/2026 01:17:13 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
12/24/2025 and conducted by Evaluator Armando Perez

COMPLAINT CONTROL NUMBER: 18-AS-20251224104830

FACILITY NAME:	PACIFIC VISTA SENIOR LIVING		FACILITY NUMBER:	331880572
ADMINISTRATOR:	TENG, JAMIE		FACILITY TYPE:	740
ADDRESS:	17085 BIRCH HILL ROAD		TELEPHONE:	(951) 398-7331
CITY:	RIVERSIDE	STATE: CA	ZIP CODE:	92504
CAPACITY:	6	CENSUS: 6	DATE:	03/11/2026
		UNANNOUNCED	TIME BEGAN:	11:54 AM
MET WITH:	Administrator Jamie Teng		TIME COMPLETED:	01:30 PM

ALLEGATION(S):

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Staff is not providing healthcare assistance

INVESTIGATION FINDINGS:

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Licensing Program Analysts (LPAs), Armando Perez and Valerie Flores, conducted an unannounced visit to deliver findings for a complaint investigation regarding the above allegation. LPA Perez met with Administrator, Jamie Teng, and explained both the purpose of the visit and the details of the allegation.

On December 24, 2025, the Community Care Licensing Division (CCLD) received a complaint that staff is not providing healthcare assistance. It was alleged that Resident 1 (R1), who is visually impaired, did not receive necessary healthcare assistance from facility staff. Interview with Additional Witness 1 (AW1) indicated that during a telephone conversation, R1 reported having vision issues and difficulty writing down the information being provided to them. AW1 stated that R1 did not report any facility neglect, and that AW1’s concerns were based solely on their telephone conversations with R1. Interview with Administrator Jamie Teng revealed that facility staff are available to assist with healthcare telephone calls, however, appointments were primarily set up independently or by responsible parties such as legal power of attorneys.
Continued on LIC 9099-C.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Jazmond D Harris
LICENSING EVALUATOR NAME: Armando Perez
LICENSING EVALUATOR SIGNATURE:	DATE: 03/11/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/11/2026

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 18-AS-20251224104830

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: PACIFIC VISTA SENIOR LIVING	FACILITY NUMBER: 331880572
	VISIT DATE: 03/11/2026

NARRATIVE

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Administrator emphasized that staff assist residents in gaining access to support services as outlined in the Admission Agreement signed by each resident. Interview with R1 indicated that they independently arrange their own healthcare services and stated that staff will provide assistance when requested. R1 acknowledged having a visual impairment, however, reported that they are able to operate both their personal cellphone and the facility phone, as well as make their own healthcare appointments. Interviews with two out of two residents corroborated the statements made by the Administrator and R1 that they independently make healthcare appointments. R2 reported that they independently schedule their own healthcare appointments and that staff assist by maintaining a calendar with reminders for them. R3 reported that they independently make one phone call to their medical provider and can get their healthcare set up. Interviews with two out of two staff indicated that they have assisted residents by making telephone calls for healthcare purposes and acknowledged reading medical letters for residents upon request. A review of records, including R1’s Admission Agreement, showed that the facility is responsible for assisting residents in gaining access to supportive services, which may include medical, dental, and other healthcare services. The agreement supports statements made by the Administrator that staff provide assistance when requested; however, healthcare services are primarily arranged independently by residents or their responsible parties. A review of R1’s medical assessment revealed R1 is capable of communicating needs, able to manage their own cash resources and able to store their own medications, supporting statements of independence.

Based on interviews and record reviews the allegation that staff is not providing healthcare assistance has been deemed UNSUBSTANTIATED. A finding that the allegation is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove that the alleged violation occurred.

An exit interview was conducted. A copy of this report was provided to Administrator Jamie Teng.

SUPERVISORS NAME: Jazmond D Harris
LICENSING EVALUATOR NAME: Armando Perez
LICENSING EVALUATOR SIGNATURE:	DATE: 03/11/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/11/2026

LIC9099 (FAS) - (06/04)

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