374604176-4-27-2025-18-AS-RORN-DGEP22-20250506105513

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 374604176
Report Date: 04/27/2025
Date Signed: 04/27/2025 11:55:35 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
09/30/2024 and conducted by Evaluator Elvira Gonzalez

COMPLAINT CONTROL NUMBER: 18-AS-20240930113845

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:	12:00 PM

ALLEGATION(S):

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Staff does not prevent resident from threatening another resident.

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 allegation. 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 10/09/24, the department conducted a review of records, and requested and obtained copies of pertinent documentation, and conducted a tour of the entire facility. On 04/26/25, the department conducted interviews with staff #1-#5 (S1-S5), attempted to interview resident #1 (R1), and interviewed residents #2-#9 (R2-R9). The department requested and received the following documents: staff roster, resident roster, Residence and Care Agreement, Identification and Emergency Information, Physician’s Report, Needs and Services Plan and facility notes for R2. 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 18-AS-20240930113845

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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On 04/27/25, the department received the following documents: Face Sheet, Identification and Emergency Information, Physician's Report, Preplacement Appraisal Information, Needs and Services Plans for R1.

The investigation revealed the following:

Allegation: Staff does not prevent resident from threatening another resident. It is being alleged that a resident has been threatened several times by another resident. It is also alleged that the resident attempted to report the issue to a manager, but nothing has been done about these incidents. On 04/26/25, between 10:25 AM and 12:00 PM, the department interviewed S1-S5. Based on interviews conducted, 3 out of 5 staff interviewed denied the allegation, and 2 out of 5 staff interviewed did not know of the allegation happening. 5 out of 5 staff interviewed stated that the facility ensures that all residents feel and are safe and comfortable in the facility.

On 04/26/25, between 01:10 PM and 02:40 PM, the department attempted to interview R1 and interviewed R2-R9. Based on interviews conducted, 4 out of 8 residents interviewed stated that no resident has threatened another resident in the facility, and 4 out of 8 residents interviewed stated that they don’t know of a resident being threatened by another resident in the facility. The department was unable to interview R1 for an answer. 8 out of 8 residents interviewed stated that no resident has ever threatened them, and the department was unable to interview R1 for an answer. 7 out of 8 residents interviewed stated that they feel safe and comfortable in this facility, and 1 out of 8 residents interviewed stated that they did not feel safe and comfortable at this facility. The department was unable to interview R1 to get an answer.

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.

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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