Pacific Vista Senior Living

Allegation investigated: Staff is not providing healthcare assistance

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 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.the state’s words, verbatim · CDSS document, Mar 11, 2026 · control 18-AS-20251224104830

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA), Armando Perez and Valerie Flores made an unannounced visit to the facility for the purpose of conducting a required annual inspection. The LPA was granted entry by staff to conduct the inspection and met with administrator, Jamie Teng. The LPA informed the Administrator of the purpose for the visit. The inspection included the following: LPA toured the facility inside and outside. LPA observed the facility to be clean and in good repair. The facility consists of six (6) resident bedrooms, four (4) bathrooms, a kitchen and dinning area, a living room area, a garage and laundry room, and a patio and yard with sufficient seating and space for activities. The home is maintained at a comfortable temperature for the clients. Lighting is sufficient for safety and comfort. Water temperature measured within regulation. Laundry facilities and a locked cabinet is present for storing laundry soap. All outdoor and indoor passageways are free of obstruction. Emergency lighting is available. There is a telephone working at this location. The LIC 610, emergency disaster plan is maintained. There are no firearms at this home and no bodies of water observed. LPA began review of client records. six (6) records were reviewed. LPA reviewed for identification and emergency information, admission agreement, medical assessment, and TB test results, needs and service plans, placement, functional assessment, centrally stored medication/destruction records, safeguard for personal property/valuables, and personal rights notification. LPA observed client pre appraisals missing on 6 of 6 clients and needs and service plans incomplete for 3 out of 6 clients. A deficiency will be issued. Continued on 809-C. LPA began review of employee records- Three (3) records were reviewed. LPA reviewed employee records for first aid certification, criminal record clearance or an exemption, health screening and TB test results, employee rights, training verification, and current administrator certification; expiration date 07/30/2027. LPA observed personnel records to be available and complete. LPA observed facility kitchen had the ability to prepare food in clean environment and possessed equipment in good working condition. Food supply meets the requirement of one (1) week supply of nonperishable and two (2) day supply of perishables. Emergency food and water supply is present. There is a locked location for sharps in the kitchen. Medications are centrally stored. There is a locked cabinet in the hallway allocated for medication storage. Centrally stored medication and destruction logs are maintained. Medications reviewed had discrepancies in 4 of 4 residents reviewed. A deficiency will be issued. LPA made observation throughout the inspection process to assess if the facility remains in conformity with the State Fire Marshall regulations. Smoke detectors and carbon monoxide detectors were tested and found to be operational. Fire extinguisher was purchased on January 2026. Emergency drills are conducted quarterly at the facility with the last drill on 02/03/2026. Based on the information received during this visit today in the areas reviewed, there are deficiencies that are being cited per Title 22, Division 6 of The California Code of Regulations. This LIC 809, LIC 809-D, Appeal Rights was reviewed with the facility representative and a copy was provided.the state’s words, verbatim · CDSS document, Mar 11, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA), Armando Perez made an unannounced visit to the facility for the purpose of conducting a required annual inspection. The LPA was granted entry by staff to conduct the inspection and met with administrator, Jamie Teng. The LPA informed the Administrator of the purpose for the visit. The inspection included the following: LPA toured the facility inside and outside. LPA observed the facility to be clean and in good repair. The facility consists of six (6) resident bedrooms, four (4) bathrooms, a kitchen and dinning area, a living room area, a garage and laundry room, and a patio and yard with sufficient seating and space for activities. The home is maintained at a comfortable temperature for the clients. Lighting is sufficient for safety and comfort. Water temperature measured within regulation. Laundry facilities and a locked cabinet is present for storing laundry soap. All outdoor and indoor passageways are free of obstruction. Emergency lighting is available. There is a telephone working at this location. The LIC 610, emergency disaster plan is maintained. There are no firearms at this home and no bodies of water observed. LPA began review of client records. six (6) records were reviewed. LPA reviewed for identification and emergency information, admission agreement, medical assessment, and TB test results, needs and service plans, placement, functional assessment, centrally stored medication/destruction records, safeguard for personal property/valuables, and personal rights notification. LPA observed client records to be available and complete. Continued on 809-C. LPA began review of employee records- Three (3) records were reviewed. LPA reviewed employee records for first aid certification, criminal record clearance or an exemption, health screening and TB test results, employee rights, training verification, and current administrator certification; expiration date 07/30/2025. LPA observed personnel records to be available and complete. LPA observed facility kitchen had the ability to prepare food in clean environment and possessed equipment in good working condition. Food supply meets the requirement of one (1) week supply of nonperishable and two (2) day supply of perishables. Emergency food and water supply is present. There is a locked location for sharps in the kitchen. Medications are centrally stored. There is a locked cabinet in the hallway allocated for medication storage. Centrally stored medication and destruction logs are maintained. Medications reviewed appear to have been dispensed accurately. LPA made observation throughout the inspection process to assess if the facility remains in conformity with the State Fire Marshall regulations. Smoke detectors and carbon monoxide detectors were tested and found to be operational. Fire extinguishers will need service on 12/31/2025. Fire drills are conducted quarterly at the facility with the last drill on 03/01/2025. Based on the information received during this visit today in the areas reviewed, there are no deficiencies that are being cited per Title 22, Division 6 of The California Code of Regulations. This LIC 809 report was reviewed with the facility representative and a copy was provided.the state’s words, verbatim · CDSS document, Mar 25, 2025

Type of visit: Case Management - Other

Licensing Program Analyst (LPA) Lydia Martinez, made this Case Management visit in conjunction with complaint investigation visit for numbers 18-AS-20230130142356 and 18-AS-20230616162648. LPA met with Evangeline dela Rosa and reason for visit was shared. Administrator Jamie Teng was informed of LPA LPA's presence at the facility. There were six residents present during visits conducted on 11/21/2024, 12/10/2024 and 12/13/2024. Residents were observed clean and warm. Facility was maintained at a comfortable temperature for the residents in care. The needs of the residents in care appeared to be met. During the investigation, LPA toured the facility and observed the following: On 11/21/2024 LPA observed six (6) bottles of vitamins/medication (picture) in a Ziploc bag in the kitchen refrigerator. Staff removed the bag and locked it away. On 12/10/2024, LPA observed the same Ziploc bag of vitamins in the kitchen refrigerator and staff removed the bag. Same Ziploc bag with vitamins was again observed in the kitchen refrigerator on today's date. Staff removed the bag of vitamins. On 11/21/2023 and 12/10/2023, LPA observed the facility’s perishable food supply to be less than the requirement for the residents in care. On today's date, LPA observed plenty of fruits and vegetables for the residents. LPA observed Resident 1 (R1) with 3 half bed rails tied with a shoelace around R1’s bed (2 half bed rails to make a full rail and 1 half bed rail at the feet.) Per staff R1 is not receiving hospice care. LPA noted two (2) mounted Fire Extinguishers that were last services on 07/24/2017. On 11/21/2024 and 12/10/2024, and 12/13/2024, LPA observed the following old furniture in the backyard; commodes, wheelchairs, hospital beds, mattresses and two old recliners. LPA also noted 2 staff rooms in the three car garage that are not on the displayed facility floor plan. Based on the observations made on 11/21/2024, 12/10/2024 and 12/13/2024, deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted and a copy of LIC809, LIC809D, LIC9102 and Appeal Rights were sent to email on file.the state’s words, verbatim · CDSS document, Dec 13, 2024

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(h)(2) · Plan of correction due date: Dec 16, 2024

Incidental Medical and Dental Care Services. Centrally stored medications shall be kept in a safe locked place that is not accessible to persons other than employees responsible for the supervision of the medication. This requirement is not being met as evidenced by: Licensee failed to ensure medications are inaccessible to residents in care. On 11/21/24 & 12/10/24 & 12/13/2024, LPA observed Ziploc bag with 6 bottles of vitamins in kitchen refrigerator. This poses an immediate health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Dec 13, 2024

Plan of correction: Administrator agrees to secure all medication at all times. Administrator to read section cited, conduct in-service with staff and submit proof of understanding and training to LPA Lydia Martinez by 12/16/2024.

From the deficiency page — Deficiency type: Type A · Section cited: CCR87203 · Plan of correction due date: Dec 16, 2024

Fire Safety: All facilities shall be maintained in conformity with the regulations adopted by the State Fire Marshal for the protection of life and property against fire and panic. This requirement was not met as evidenced by: LPA observed Fire Extinguishers mounted on the wall were last serviced on 07/24/2017. This poses an immediate Health & Safety risk to the residents in care.the state’s words, verbatim · CDSS document, Dec 13, 2024

Plan of correction: Administrator to immediately have the Fire Extinguishes serviced or replaced. Fire extinguishers are to be serviced annually. Submit proof of correction to LPA Martinez by 12/16/2023.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87608(a)(5)(A)(B) · Plan of correction due date: Dec 20, 2024

Postural Supports: (a) Based on the individual's preadmission appraisal, and subsequent changes...Postural supports may be used under the following conditions. (5) Under no circumstances shall postural supports...(A) A bed rail that extends from the head half the length of the bed and... (B) Bed rails that extend the entire length of the bed are prohibited except for residents who are currently receiving hospice care...This requirement was not met as evidenced by: Based on LPA’s observation, AD did not comply with the section cited in that R1’s bed has 3 half bed rails tiedthe state’s words, verbatim · CDSS document, Dec 13, 2024

Plan of correction: Administrator to remove the bed rails and/or obtain physician orders for the one half-bed rail if there is a need and submit proof to LPA Martinez 12/19/2024.. together with shoelaces, (2 half bed rails make a full bed rail and a half bed rail at the feet.) R1 is not receiving Hospice care. This poses a potential Health, Safety or Personal Rights risk to the resident in care.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87555(b)(26) · Plan of correction due date: Dec 16, 2024

General Food Service Requirements: Supplies of nonperishable foods for a minimum of one week and perishable foods for a minimum of two days shall be maintained on the premises. This requirement was not met at evidenced by: Based on LPA’s observation on 11/21/24 and 12/10/24, Licensee did not comply with the section cited in that there was not enough non-perishable and perishable food supply to sustain 7 days with 6 residents.the state’s words, verbatim · CDSS document, Dec 13, 2024

Plan of correction: Defiency Cleared during visit. LPA observed plenty of food, including vegetables and fruits. Administrator to ensure non-perishable and perishable food supplies will be replenished at all times.

Allegation investigated: Staff did not assist resident when they reported breathing issues Staff did not respond to resident when requesting food and water Staff threatened and yelled at resident Staff recorded resident in their bedroom without consent

Licensing Program Analyst (LPA) Lydia Martinez conducted an unannounced visit to deliver findings on the above allegations. LPA was greeted and granted entry into the facility by Evangeline dela Rosa and Edgardo Gonzales. LPA spole to Administrator Jamie Teng via telephone and reason for the visit was shared. During the course of the investigation, LPA toured the facility and interviewed staff and residents as well as obtained and reviewed pertinent documentation such as Resident Roster, Staff schedule, and Unusual Incident Report dated 01/26/2023. LPA observed facility to be clean and in good repair and observed residents to be well groomed and relaxing in their respective rooms on 11/21/2024 and 12/10/2024. Regarding allegation that staff did not assist resident when they reported breathing issues. LPA interviewed 2 of 2 staff (S1 and S2). S1 stated there is only one resident who uses a breathing machine (vaporizer). S1 stated resident will tell the staff of their need for the machine due to breathing issues and S1 or S2 will assist the resident. S2 also stated there is only one resident who uses a breathing machine, and will help resident when needed. S1 and S2 both denied that staff does not assist the resident when they are having breathing issues. Unsubstantiated Regarding allegation that Staff did not respond to resident when requesting food/water. LPA interviewed 2 of 2 staff, (S1 and S2). S1 stated residents are given three meals and two snacks every day. S1 stated the residents are encouraged to drink water throughout the day to stay hydrated. S2 stated he makes sure residents eat their breakfast, lunch and dinner and that the residents stay hydrated. Both S1 and S2 stated they would never deny a resident food or water if its requested. LPA interviewed R1 and R2. R1 stated food is good but could be better; would like to have more servings of fruits and vegetables. R1 is given food and water if requested. R2 denied allegation and added that the food is always excellent. During today's visit, LPA observed staff receiving a text message from Resident 6 (R6) requesting lunch. Staff prepared rice for the R6 per request. Regarding allegation that staff threatened and yelled at resident. Interview with 2 of 2 staff (S1 and S2) and the Administrator (AD), AD denied yelling at any resident and stated he has never heard or received a complaint from a resident that staff yell at the residents. S1 denied yelling or hearing other staff yell at any resident. S1 did state there is a resident who yells at staff but staff would never yell at any resident. S2 stated he would not yell at a resident and denied hearing a staff member yell at the any resident. LPA interviewed R1 and R2. Both R1 and R2 denied being yelled or have not heard staff yell at residents. Regarding allegation that staff recorded resident in their bedroom without consent. LPA interviewed 2 of 2 staff (S1 and S2) and the Administrator (AD). AD stated he has never recorded a resident with or without their consent. Both S1 and S2 stated they have not seen or heard of any staff member record any resident. Interview with R1 and R2, both stated they do not know if they or any resident has been recorded. LPA interviewed two of six residents (R1 and R2) on allegations above. Three of six residents were unable to answer questions due to their diagnosis and the fourth resident avoided communication with LPA. LPA was unable to verify above allegations occurred as reported. Although the above-mentioned allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur therefore the allegations are Unsubstantiated. An exit interview was conducted with AD and a copy of this report was sent to email on file.the state’s words, verbatim · CDSS document, Dec 10, 2024 · control 18-AS-20230130142356

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Javina George made an unannounced visit to the facility for the purpose of conducting a 1 year required visit/annual inspection. LPA was greeted and granted entry by Caregiver Evangeline Dela Rosa, where LPA explained the purpose of the visit. At the time of the visit there was three staff and six residents present. Staff #1 (S1) was observed to not have obtained proper fingerprint clearance, nor to be associated to the facility, and was escorted off the premises, an immediate $500 civil penalty is being assessed. The Administrator Jamie Teng, was unavailable to come to the facility as they were out conducting resident interviews but was available via telephone. LPA conducted a tour of the interior and exterior of the facility. The facility was observed to be clean and clutter free. LPA observed for there to be several games, available for the residents to play and interact with one another. The medications were observed to be locked and inaccessible to residents in care. LPA did not observe an adequate supply of hygiene items, or personal protective equipment (PPE). There is a covered patio, with plenty of seating available. LPA observed for there to be two (2) added on staff bedrooms inside the garage. Staff on grounds denied being live in caregivers, and that the rooms are used to take breaks. The facility needs to be updated and submitted to the regional office. Food service: the facility was observed to have a 2 day supply of perishable and a 7 day supply of non perishable food items. LPA observed for the facility to have expired food items such as oatmeal, cream of wheat, box mashed potatoes, canned goods, corn bread mix dating back to May 2021. The expired food items were discarded at the time of LPAs visit, therefore a citation was not issued. The hot water was tested in all three resident bathrooms and was found to be within regulatory limits, measuring 106.5-115.3 degrees Fahrenheit. It is unknown as to when the last emergency disaster drill was conducted as the logs were unavailable for LPA to review. The facility does not have an active mitigation plan on file that was submitted to the regional office, in addition the smoke detectors were not operable, as they could not be tested, LPA observed for the cover to be open with no battery inside. The facility does not have a carbon monoxide detector, an immediate $500 civil penalty is being assessed. LPA was unable to review both staff and resident files as per Jamie Teng, Administrator, the facility has gone all electronic and he had the documents with him. Jamie stated that he would send the docs, however they were not received during LPAs inspection. The facility was observed to have the required postings, the emergency disaster plan was observed to not have been updated since 05/01/2018. The following is to to be submitted to the regional office: -LIC808 Mitigation plan, LPA emailed PIN 20-48-ASC to the Administrator for review -Updated facility sketch -Emergency disaster plan (LIC610E) -(3) Staff files requested -(3) Resident files requested -Image/video of additional hygiene supplies and personal protective equipment (PPE) As a result of today's inspection a meeting will be held at the regional office, in order to discuss the facility getting into compliance. Based on today's inspection deficiencies are being issued/cited in accordance with the California Code of Regulations (Title 22, Division 6, Chapter 8) on the attached 809D. An exit interview was conducted and a copy of this report, appeal rights, 809D, LIC421BG, LIC421IM and LIC 9098 Proof of Corrections for was reviewed and provided to Evangeline Dela Rosa.the state’s words, verbatim · CDSS document, Apr 2, 2024

Allegation investigated: Staff failed to administer residents' medication as prescribed

Licensing Program Analyst (LPA) Javina George made an unannounced visit to deliver findings for the allegations noted above. LPA met with Jamie Teng, Administrator and explained the purpose of the visit and the elements of the allegation noted above. The allegation was investigated, and the investigation consisted of observations, interviews and records review. Regarding the allegation of staff failed to administer resident’ medication as prescribed. Resident #1 (R1) was admitted to the facility on or around August 3, 2023. Per interviews with Administrator Jamie Teng, there is a contract or agreement with a local skilled nursing facility (SNF) to discharge residents from the SNF to the facility. However, the facility accepted residents without the residents being properly screened, as the evaluation for suitability for admission. Jamie stated that there was no admissions agreement completed, as R1 was only at the facility for a few hours when they began exhibiting aggressive behaviors, as they began to destroy their room. However, another interview conducted with facility staff revealed that R1 was at home for two (2) days and would yell at nighttime. Unsubstantiated Per an interview with SNF staff revealed that R1 was discharged, with a prescription, that was sent to a local pharmacy. In addition, per SNF staff when medication is sent to the pharmacy, the medication will be delivered the same day if not the next day. Per an interview with the local pharmacy staff revealed that R1 did have a profile with them but no medication. LPA inquired as to why there would be a profile, but no medications. The pharmacy staff explained that “it could mean the medications were cancelled, transferred, or were never sent to the pharmacy”. During the initial complaint visit conducted on 8/8/23, LPA did not observe a facility file nor documents, to confirm which medications R1 was prescribed. However, it was confirmed that R1 was discharged from the SNF to the facility and the medication was sent over to the pharmacy. There was no other explanation provided from the Administrator Jamie, other than “no R1 was not given any medication at the facility as they were not a resident. A list of medications was not provided for LPA to review from the Pharmacy, due insufficient evidence the allegation of staff failed to administer residents medication as prescribed is UNSUBSTANTIATED. A finding that the complaint 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(s) occurred. An exit interview was conducted and copy of this report, and appeal rights were reviewed and provided to Jamie Teng, Administrator.the state’s words, verbatim · CDSS document, Oct 5, 2023 · control 18-AS-20230803114230

Type of visit: Case Management - Deficiencies

Licensing Program Analyst (LPA) Javina George made an unannounced case management deficiencies visit as LPA was delivering findings for complaint control # 18-AS-20230803114230 and observed the following deficiency. The facility admitted (accepted responsibility) for Resident #1 (R1) on or around August 3, 2023. Per interviews with Administrator Jamie Teng, there is a contract or agreement with a local skilled nursing facility (SNF) to discharge residents from the SNF to the facility. However, the facility is accepting residents without properly screening them, as well as not completing the evaluation of suitability for admission. The evaluation consists of: (1) Conduct an interview with the applicant and his responsible person. (2) Perform a pre-admission appraisal. (3) Obtain and evaluate a recent medical assessment). As a result of the facility not properly screening new residents. R1 was admitted to the facility and began exhibiting aggressive behaviors such as banging their head against the wall, and trying to throw furniture. As a result the facility had to contact 9-11 to assist, and have R1 removed without returning to the facility. This poses a potential health, safety and personal rights risk to persons in care. The following is being cited in accordance with the California Code of Regulations (Title 22, Division 6, Chapter 8). An exit interview was conducted and a copy of this report, and appeal rights were reviewed and provided to Administrator Jamie Teng.the state’s words, verbatim · CDSS document, Oct 5, 2023

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87456(a)(1-3) · Plan of correction due date: Oct 20, 2023

87456 Evaluation of Suitability for Admission (a)(1-3) Prior to accepting a resident for care and in order to evaluate his/her suitability, the facility shall, as specified in this article 8: (1) Conduct an interview with the applicant and his responsible person. (2) Perform a pre- admission appraisal. (3) Obtain and evaluate a recent medical assessment. This requirement is not met as evidenced by: The licensee failed to conduct an evaluation for R1, 1 time. This posed a potential health, safety and personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Oct 5, 2023

Plan of correction: The licensee agrees to submit a personal statement self certifying that any new residents moving forward the facility will conduct an evaulation of suitability.