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

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374604134
Report Date: 03/30/2025
Date Signed: 03/30/2025 12:13:48 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
07/08/2024 and conducted by Evaluator Alfonso Iniguez
PUBLIC
COMPLAINT CONTROL NUMBER: 18-AS-20240708162702
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:
03/30/2025
UNANNOUNCEDTIME BEGAN:
08:15 AM
MET WITH:Diane Domingo/Executive Director TIME COMPLETED:
12:13 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff handles resident in a rough manner.
Staff threatens resident.
Staff does not treat resident with dignity and respect.
Staff stole resident’s personal belongings.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 3/30/2025 at approximately 8:15 AM, LPA Alfonso Iniguez conducted an unannounced subsequent complaint visit. At approximately 8:30 AM, LPA Iniguez met with Diane Domingo / Executive Director. LPA Iniguez explained the purpose of this visit.

Investigation Consisted of: LPA obtained and reviewed the following documents: Personnel Report or LIC 500 dated: 3/18/25, (R#1)’s Physicians Report for Residential Care Facilities for the Elderly or LIC 602A dated: 10/3/24 and (R#1)’s, (R#1)’s Client/Resident Personal Property and Valuables or LIC 621 dated: 12/5/23, (R#1)’s Inventory List from hospital dated: 11/27/23, and facility staff training records regarding residents personal rights dated: 2024.


Evaluation Report continues LIC 9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Alfonso Iniguez
LICENSING EVALUATOR SIGNATURE:

DATE: 03/30/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/30/2025
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-20240708162702
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: 03/30/2025
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Investigation Revealed the Following:

Allegation: Staff handles resident in a rough manner.

The details of the complaint alleged that facility staff throw (R#1) in bed in roughly manner.

On March 29, 2025, at approximately 9:00 AM, during a review of records, LPA Iniguez examined the hospital discharge records for (R#1) dated: 7/7/24. On 7/7/24, (R#1) went to the hospital due to shortness of breath (SOB) via ambulance. In the social work notes, LPA Iniguez noted that both the doctor and the registered nurse indicated that there was no physical evidence of trauma found during this hospital visit. In addition, LPA Iniguez observed (R#1)’s Physicians Report for Residential Care Facilities for the Elderly or LIC 602A dated: 10/3/24. In the report it is noted that (R#1)’s has a cognitive condition that may influence their behavior.

On March 29, 2025, at approximately 10:30 AM, during an interview with the Administrator (A#1), she stated that the facility staff receives training on residents' personal rights annually and upon hiring. Furthermore, (A#1) mentioned that the facility staff did not mishandle resident (R#1) or any other residents in their care. An addition, (A#1) stated that she did not provide direct care to (R#1) or any other residents in care.

On March 29. 2025, at approximately 11:50 AM, during an interview with (R#1) by bedside, (R#1) stated that they do not recall the time and date when the “male administrator “threw them into the bed roughly.

On March 29, 2025, at approximately 3:00 PM, during interviews with residents (R#1-R#5), (4) out of (5) stated that the facility staff had not handled them roughly.

On March 29, 2025, at approximately 2:00 PM, during interviews with facility staff (S#1-S#5), (5) out of (5) stated that they received training every year regarding residents’ rights. Also, (5) out of (5) facility staff stated that they have not handled (R#1) or any other resident in care in a rough way.

Evaluation Report continues LIC 9099-C

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Alfonso Iniguez
LICENSING EVALUATOR SIGNATURE:

DATE: 03/30/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/30/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 6
Control Number 18-AS-20240708162702
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: 03/30/2025
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Allegation: Staff threatens resident.

The details of the complaint alleged that facility administrator threatened (R#1) to “make it harder” for them at the facility.

On March 30, 2025, at approximately 11:30 AM, during records review LPA observed (R#1) admissions agreement dated 11/27/23, it is written that if (R#1) desires to leave facility a 30-day notice needs to be done.

On March 29, 2025, at approximately 10:30 AM, during an interview with Administrator (A#1), she stated that she had not threatened (R#1) or any other residents in any way. In addition (A#1) stated that if a resident wishes to leave the facility a 30-day noticed if required.

On March 29. 2025, at approximately 11:50 AM, during an interview with (R#1) by bedside, (R#1) stated that the male administrator threatened them to “make it harder for them”. (R#1) was not able to give more details about this allegation.

On March 29, 2025, at approximately 3:00 PM, during interviews with residents (R#1-R#5), (4) out of (5) stated that they have not been threatened by facility administrator in any way.

On March 29, 2025, at approximately 2:00 PM, during interviews with facility staff (S#1-S#5), (5) out of (5) stated that they had not seen or heard the facility administrator threaten (R#1) or any other resident in care in any way.

Evaluation Report continues LIC 9099-C

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Alfonso Iniguez
LICENSING EVALUATOR SIGNATURE:

DATE: 03/30/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/30/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 6
Control Number 18-AS-20240708162702
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: 03/30/2025
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Allegation: Staff does not treat resident with dignity and respect.

The details of the complaint alleged that facility staff makes fun of (R#1)

On March 29, 2025, at approximately 10:00 AM, LPA Iniguez requested copies of facility staff training regarding resident personal rights; facility staff stated that these records would be provided late today or on 3/30/25. On March 30, 2025, at approximately 9:30 AM, LPA Iniguez reviewed facility staff online-in-service training dated 2024. LPA Iniguez observed that all facility staff have completed the online Resident Rights & Abuse Reporting course v.1.

On March 29, 2025, at approximately 10:30 AM, during an interview with the Administrator (A#1), she stated that the facility staff, including herself, provide resident (R#1) and the other residents with dignity and respect during interactions.

On March 29. 2025, at approximately 11:50 AM, during an interview with (R#1) by bedside, (R#1) stated that the facility staff made “fun of them”. (R#1) was unable to provide names of facility staff or what has been said during this interaction.

On March 29, 2025, at approximately 3:00 PM, during interviews with residents (R#1-R#5), (4) out of (5) stated that the facility staff treats them with dignity and respect, and they did not

On March 29, 2025, at approximately 2:00 PM, during interviews with facility staff (S#1-S#5), (5) out of (5) stated that they treated (R#1) and all the residents in care with dignity and respect.

Evaluation Report continues LIC 9099-C

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Alfonso Iniguez
LICENSING EVALUATOR SIGNATURE:

DATE: 03/30/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/30/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 6
Control Number 18-AS-20240708162702
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: 03/30/2025
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Allegation: Staff stole resident’s personal belongings.

The detail of the complaint alleges that facility staff had stolen (R#1) curtains from their room.

On March 30, 2025, at approximately 9:00 AM, during the records review, LPA Iniguez observed (R#1)’s Inventory list from hospital discharge paperwork dated 11/27/23. LPA Iniguez observed that the inventory list does not show any items listed. In addition, LPA Iniguez reviewed the (R#1) Client/Resident Personal Property and Valuables or LIC 621 dated 12/5/23; also, there are no items listed in this form.

On March 29, 2025, at approximately 10:30 AM, during an interview with the administrator (A#1), she stated that the facility staff is not stealing (R#1) or neglecting other residents' care of their personal belongings. In addition, (A#1) stated that the theft and loss policy is in place.

On March 29. 2025, at approximately 11:50 AM, during an interview with (R#1) by bedside, (R#1) stated that the facility staff sole all the curtains from their room. However, LPA Iniguez observed that blinds were set up in (R#1)’s room.

On March 29, 2025, at approximately 10:00 AM, during interviews with residents (R#1-R#5), (4) out of (5) stated that they don’t believe facility staff are taking their personal belongings.

On March 29, 2025, at approximately 2:00 PM, during interviews with facility staff (S#1-S#5), (5) out of (5) stated that they did not take (R#1)’s or other residents in care personal belongings.

Evaluation Report continues LIC 9099-C

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Alfonso Iniguez
LICENSING EVALUATOR SIGNATURE:

DATE: 03/30/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/30/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 6
Control Number 18-AS-20240708162702
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: 03/30/2025
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
During this investigation, LPA found did not find sufficient evident to support the above-mentioned allegation(s).

Based on the evidence gathered, interviews conducted, and records reviewed, the preponderance of evidence standard has been met; therefore, the above-mentioned allegation(s) are found to be UNSUBSTANTIATED.

Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur.

An exit interview was conducted, and a copy of the Complaint Report was given to Crystal Naranjo/Memory Care Coordinator.

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Alfonso Iniguez
LICENSING EVALUATOR SIGNATURE:

DATE: 03/30/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/30/2025
LIC9099 (FAS) - (06/04)
Page: 6 of 6