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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 374604274
Report Date: 12/30/2025
Date Signed: 12/30/2025 11:35:18 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
09/26/2024 and conducted by Evaluator Antonine Richard
COMPLAINT CONTROL NUMBER: 18-AS-20240926160035
FACILITY NAME:VISTA DEL LAGO MEMORY CAREFACILITY NUMBER:
374604274
ADMINISTRATOR:MARIE HILLFACILITY TYPE:
740
ADDRESS:1817 AVENIDA DEL DIABLOTELEPHONE:
(760) 741-2888
CITY:ESCONDIDOSTATE: CAZIP CODE:
92029
CAPACITY:96CENSUS: 89DATE:
12/30/2025
UNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:MARIE HILLTIME COMPLETED:
11:45 AM
ALLEGATION(S):
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Staff did not provide the medication as prescribed.
Staff is not providing proper hygiene assistance to resident and not providing clean fresh clothing.
Staff is not responding to the needs of the residents.
INVESTIGATION FINDINGS:
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On December 30, 2025, Licensing Program Analyst (LPA) Antonine Richard conducted a subsequent complaint visit to deliver findings. LPA met with the Executive Director (A1), Marie Hill, and explained the purpose of the visit.

The complaint investigations consisted of the following:
On December 17, 2025, LPA Richard met with Loucinda Hickerson, Memory Care Director (MCD), and explained the purpose of the visit. Later, the Executive Director, Marie Hill (ED), joined. During the visit, LPA Richard requested and received copies of the following: Staff Roster (dated 12/17/25), Resident Roster (dated 12/15/25), R1 Face Sheet, Admission Agreement (dated 07/08/24), Physician’s Report (dated 06/06/24), Needs and Services Plan (dated 3/26/24), R1’s Medication Administration Record (MAR) (dated 09/01/24 to 09/30/24), Facility Notes (dated 07/01/24 to 11/30/24), Med Technician Training Certificate (dated 03/09/23). LPA Richard also conducted interviews with the Executive Director (A1), Memory Care Director (MDC), six residents (R2-R7), four staff members (S1-S4), and two Med Techs (MT1-MT2).
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Antonine Richard
LICENSING EVALUATOR NAME: Antonine Richard
LICENSING EVALUATOR SIGNATURE:

DATE: 12/30/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/30/2025
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 4
Control Number 18-AS-20240926160035
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: VISTA DEL LAGO MEMORY CARE
FACILITY NUMBER: 374604274
VISIT DATE: 12/30/2025
NARRATIVE
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Allegations #1: Staff did not provide the medication as prescribed.

The complaint alleged that the facility failed to administer medication as prescribed. On December 17, 2025, Licensing Program Analyst (LPA) Antonine Richard interviewed the Administrator (A1), who denied the allegation and stated that the Med Techs were being trained to administer medications to the residents. LPA also interviewed the Memory Care Director (MDC), who likewise denied the allegation.

Additionally, LPA interviewed six residents #2-7 (R2-R7), all of whom denied the allegation and reported that staff provided their medications on time and without mistakes. LPA also interviewed four staff members (S1-S4), who denied the allegations and noted that they only assisted residents with their medications.

During the same visit, LPA interviewed two Med Techs (MT1 and MT2), who denied the allegations and asserted that they followed the doctor's orders. They explained that if a prescription arrived from the pharmacy without the doctor's orders, they would contact the doctor and the pharmacy to have the necessary paperwork faxed before administering the medications. On December 17, 2025, LPA reviewed the medication administration records for five residents. MARs dated 09/01/2024 to 09/30/2024 showed no discrepancies. LPA was unable to interview R1 because R1 moved out of the facility on 11/06/2024.

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

Report Continued on LIC9099C.

SUPERVISORS NAME: Antonine Richard
LICENSING EVALUATOR NAME: Antonine Richard
LICENSING EVALUATOR SIGNATURE:

DATE: 12/30/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/30/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 18-AS-20240926160035
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: VISTA DEL LAGO MEMORY CARE
FACILITY NUMBER: 374604274
VISIT DATE: 12/30/2025
NARRATIVE
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Allegation #2: Staff are not providing proper hygiene assistance to residents and not providing clean, fresh clothing.

The complaint alleged that a resident who has been at the facility for 2 months has had only two baths and wears the same clothes. On December 17, 2025, Licensing Program Analyst (LPA) Antonine Richard interviewed the Administrator (A1), who denied the allegation and stated that Resident #1 (R1) is very vocal. R1 would demand assistance from staff if R1 feels neglected. LPA also interviewed the Memory Care Director (MDC), who similarly denied the allegation.

Additionally, LPA interviewed six residents (R2-R7), all of whom denied the allegation and reported that residents have scheduled showers and can refuse to be showered if they choose. LPA also interviewed four staff members (S1-S4), who denied the allegations and noted that R1 often refuses to take showers and change clothes. Since R1 has the right to refuse, the staff could not force R1.

During the same visit, the LPA interviewed two Med Techs (MT1 and MT2), who denied the allegations and stated that staff tried to assist all residents needing help with showers and changing clothes. On December 17, 2025, the LPA reviewed the facility records from 07/01/2024 to 11/30/2024, which showed that R1 refused assistance from the caregiver multiple times with R1's Activities of Daily Living (ADLs). At the same time, the LPA also reviewed the facility's shower schedule for each resident. The LPA observed that most of the residents interviewed and those in the TV room were wearing clean clothes. LPA was unable to interview R1 because R1 moved out of the facility on 11/06/2024.

Report Continued on LIC9099C

SUPERVISORS NAME: Antonine Richard
LICENSING EVALUATOR NAME: Antonine Richard
LICENSING EVALUATOR SIGNATURE:

DATE: 12/30/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/30/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 18-AS-20240926160035
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: VISTA DEL LAGO MEMORY CARE
FACILITY NUMBER: 374604274
VISIT DATE: 12/30/2025
NARRATIVE
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Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove that the alleged violations did or did not occur; therefore, the allegation is unsubstantiated.

The allegation #3: Staff are not responding to the needs of the residents.

The complaint alleged that a resident called for help, but no one responded. On December 17, 2025, Licensing Program Analyst (LPA) Antonine Richard interviewed the Administrator (A1), who denied the allegation and stated that Resident #1 (R1) is very vocal. R1 would request assistance from staff if needed. LPA also interviewed the Memory Care Director (MDC), who similarly denied the allegation.

Additionally, LPA interviewed six residents #2-7 (R2-R7), all of whom denied the allegation and stated that the staff helped them when they needed them. The staff checked their rooms every half hour or one hour. LPA also interviewed four staff members #1-4 (S1-S4), who denied the allegations and noted that R1 rooms are closed to the Med Tech station and that staff would be able to hear if R1 asked for help. LPA was unable to interview R1 because R1 moved out of the facility on 11/06/2024.

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

No deficiencies were cited.

An exit interview was conducted, and a copy of this report was provided to the Executive Director, MARIE HILL.

SUPERVISORS NAME: Antonine Richard
LICENSING EVALUATOR NAME: Antonine Richard
LICENSING EVALUATOR SIGNATURE:

DATE: 12/30/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/30/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 4