Vista Senior Living

Allegation investigated: Staff did not ensure resident's pressure injury was covered with a dressing.

On April 22, 2026, Licensing Program Analyst (LPA), Venus Mixson arrived unannounced at the facility and met with the Facility Manager, Elena Leon. LPA explained the reason for the visit was to provide findings for the complaint investigation. During the investigation, LPA conducted interviews, record reviews, and made observations pertaining to the listed allegation. On October 14, 2025, Community Care Licensing received a complaint alleging that Staff did not ensure resident's pressure injury was covered with dressing. It was reported that on 10/13/25, the Patient was laying on their side with exposed coccyx wound. Resident #1 (R1), and that there was a pressure mattress that was being used incorrectly since R1 was laying on blanket and thick pad. When interviewed the Administrator denied the allegation. The Administrator stated R1 had just gotten out of the shower and was drying off, and at about the same time that R1 was on the bed drying off, the Home Health nurse arrived. Administrator advised that the home health nurse was overreacting. Information obtained from Interviews with staff members indicated that the incident took place in R1’s person bedroom, and that R1’s bathroom is also in their bedroom. Unsubstantiated Additional information obtained from staff members indicated that there were no concerns brought to their attention regarding the use of the pressure mattress. When interviewed, R1 stated there were no concerns since their arrival to the facility and that they have only been receiving services from Home Health for a few weeks. R1 advised that they had just recently arrived at the facility a few months ago, and that this was the first time the nurse had ever come to the facility to dress or change the bandages. There were no stated concerns or challenges with how the facility staff attended to meeting their daily needs. Information obtained from interviews with additional residents indicated there were no concerns or challenges with how the facility staff attend to their daily needs. LPA made several attempts to contact and interview additional relevant Witness to no avail. LPAs review of the records, including a sampling of the residents files, verified there were no other residents receiving care from home health for pressure injuries at the time of this investigation. Based on information obtained from interviews, record review and observations, the evidence received pertaining to the allegation Staff did not ensure resident's pressure injury was covered with dressing, has been deemed unsubstantiated. An unsubstantiated allegation means although the allegation may have happened or is valid, there is not a preponderance of evidence to demonstrate the alleged violation did or did not occur. An exit interview was conducted. A copy of this report was discussed and given to the Facility Manager, Elena Leon.the state’s words, verbatim · CDSS document, Apr 22, 2026 · control 18-AS-20251014120447

Allegation investigated: Staff does not safeguard resident's personal belongings. Staff does not ensure resident is provided a comfortable environment.

On April 22, 2026, Licensing Program Analyst (LPA), Venus Mixson arrived unannounced at the facility and met with the Facility Manager, Elena Leon. LPA explained the reason for the visit was to provide findings for the complaint investigation. During the investigation, LPA conducted interviews, record reviews, and made observations pertaining to the listed allegation. On December 10, 2025, Community Care Licensing received a complaint alleging staff does not safeguard resident's personal belongings and staff does not ensure resident is provided a comfortable environment. It was reported that Resident #1 (R1) does not feel comfortable due to someone who lives there. Additional details were not provided. It was further reported another Resident # 2 (R2) has taken R1’s personal items. It was also reported that R1 is concerned that R2 will physically harm them. Regarding the allegation staff does not safeguard resident's personal belongings, information obtained from interview with Licensee denied the allegations. Licensee advised that there was never a time when R1 or any residents, advised personal belongings were missing. Unsubstantiated Licensee stated R1 has resided at the facility since July 01, 2025 and there have not been any incidents or advisements regarding R1’s belongings. Information obtained from interviews with staff members indicated that R1 has not had a roommate since October 2025 and at that time there was no information indicating there were missing items. When interviewed, R1 stated there were no concerns or challenges with how the facility attends to their daily needs and safeguarding their personal things. R1 stated they do feel safe and there were no concerns with how the facility safeguards their personal belongings. Information obtained from interviews with additional residents indicated they have not seen or heard anything about their personal belongings missing. Information obtained from interviews with witnesses indicated they do not have any concerns regarding the personal belongings and that R1 was not able to state what items were touched or gone missing. LPAs review of the records, including emails, and R1’s personal property and valuables, confirm information obtained during interviews. Regarding the allegation Staff does not ensure resident is provided a comfortable environment. Information obtained from interview with Licensee indicated there were no advisements from R1 that there were any concerns regarding R1’s safety. Additionally, information obtained indicated there were no incidents with R1 or any of the residents. Information obtained from interviews with staff indicated there were no noted concerns with how the facility staff assure the residents have a comfortable environment. Information received from interviews with additional staff indicated R1 did not advise that they did not feel safe or that any of the residents would cause them harm. Information obtained from interview with R1 stated they were happy with living arrangements and there were no challenges with other residents or staff. Information obtained from interviews with other residents indicated there were no concerns with how the facility staff assure that they are safe. Information obtained from interview with Additional Witness stated they do not have any concerns with how the facility attends to the safety of the residents. LPA’s review of the records, including Serious Incident Reports and facility daily notes, corroborated the information obtained. LPA’s observations did not reveal any concerns with the environment being safe at the time of the unannounced visit. Based on information obtained from interviews, record reviews, and observations, the evidence received pertaining to the allegations staff does not safeguard resident's personal belongings and staff does not ensure resident is provided a comfortable environment, has been deemed unsubstantiated. An unsubstantiated allegation means although the allegation may have happened or is valid, there is not a preponderance of evidence to demonstrate the alleged violations did or did not occur. An exit interview was conducted. A copy of this report was discussed and given to the Facility Manager, Elena Leon.the state’s words, verbatim · CDSS document, Apr 22, 2026 · control 18-AS-20251210153557

Allegation investigated: Staff forcefully grabbed resident

On April 22, 2026, Licensing Program Analyst (LPA), Venus Mixson arrived unannounced at the facility and met with the Licensee, Shrikant Kakani. LPA explained the reason for the visit was to provide findings for the complaint investigation. During the investigation, LPA conducted interviews, record reviews, and made observations pertaining to the listed allegation. On October 03, 2025, Community Care Licensing received a complaint alleging Staff #1 (S1), forcefully grabbed Resident #1 (R1). It was reported that Staff #1 forcefully grabbed R1 by the wrist. Information obtained from interview with the Licensee denied the allegation occurred. Licensee stated R1 picked up documents that they were not supposed to have and Staff #1 removed the documents from R1’s hands. Licensee stated there was no force or intent of malice by Staff #1. Information obtained by Staff #1 stated that . Information obtained from interviews with additional staff members indicated that they did not see any of the staff members forcefully grab R1 by the wrist. Unsubstantiated Information obtained from an interview with R1 stated that they do not feel as though this occurred. R1 also stated that they felt that staff members do not violate their personal rights. Information obtained from interviews with additional residents indicated there were no shared concerns regarding the staff members infringing on their personal rights. LPA made numerous attempts to contact and interview additional relevant parties and was unable to obtain additional information. LPA’s review of the records, including resident and staff files, did not disclose any concerns advise of inappropriate interactions between Staff #1 or any other resident. Based on information obtained from interviews, record reviews, and observations, the evidence received regarding the allegation that staff forcefully grabbed resident, has been deemed unsubstantiated. An unsubstantiated allegation means although the allegation may have happened or is valid, there is not a preponderance of evidence to demonstrate the alleged violation did or did not occur. An exit interview was conducted and a copy of this report was discussed and given to the Licensee, Shrikant Kanani.the state’s words, verbatim · CDSS document, Apr 22, 2026 · control 18-AS-20251003153819

Type of visit: Required - 1 Year

On April 10, 2026, Licensing Program Analyst (LPA), Venus Mixson arrived at the facility unannounced to conduct the Annual Inspection and met with the Administrator, Nikita Desai. The facility file review was conducted at the Regional Office and additional records were requested and reviewed on site. The facility is licensed for 15 Elderly Adult residents and is currently operating at the capacity of 14 Elderly Adult residents. For a 740 facility type. The facility is cleared for 8 of those 15 to receive Hospices services but currently there are no residents on Hospice at this time. LPA Mixson toured the facility along with the Administrator, Nikita Desai, and made observations pertaining to the Required Annual visit. LPA inspected the facility inside and outside. There were no obstructions or debris to the indoor or outdoor passageways observed. Additionally, there were no bodies of water seen on the premises at the time of this visit. The facility is a single-story facility located at 222 Washington Street Vista Ca.92084 Physical Plant: The facility phone number is (760) 936-8887, and it is operable. LPA Mixson observed the residents’ bedrooms, from number (1) through (9), and each was furnished as per Regulations and Title 22. LPA Mixson inspected the six facility bathrooms, and each was clean and had working utilities. The hot water temperature tested within regulations, and was logged. The bathrooms were clean, and appliances were operating appropriately currently. The facility is equipped with operating smoke detectors, 9 carbon monoxide alarms located in the bedrooms, and (2) carbon monoxide alarms are located in the hallway. There are two fire extinguishers. LPA Mixson observed required postings such as "If you See Something, Say Something,” the "Personal Rights," and the LTCO poster. The cleaning supplies and sharp items were locked and inaccessible to the residents in care presently. There were designated storage spaces for the residents’ files, and it was locked and inaccessible to residents in care at present. The staff files were maintained electronically, and were provided online. Medications: Were locked in a black metal file cabinet near the laundry room and front door and inaccessible to residents in care. Additionally, there were a sufficient supply of medication for the residents in care. There were no documented errors observed on the centrally stored medication forms, and medications were stored in their original containers at the present. The facility has five caregivers present, and the Administrator for a total of six. There are two Fire extinguishers located in the facility by each entry way. In the green at the time of the visit and to be serviced on 04/15/2026 ask indicated by the Administrator. Food Service& furniture: The non-perishable and perishable food supply is sufficient per regulations, and there are a variety of food types available for residents at this time. Dishes and utensils were in sufficient supply and stored properly, and sharp items are locked. The overall facility is clean; the furniture is in good condition and arranged in a manner which provides space for residents to move safely. The facility cooling system and other appliances were operable at present. The Administrator informed LPA there were safety lights for night throughout the facility. Care & Supervision/Administration: There were adequate staff present for the supervision of residents in care. The floor plans, telephone numbers and personal rights were found posted in the facility. The listed Administrator, Nikita Desai possess a current administrator’s certificate with an expiration date of 11/28/2027, and it is posted in the facility, near the front door. Records Reviewed and Resident/Staff Files: LPA Mixson reviewed staff files and the facility's staff schedule. The staff files reviewed comprise required documents, along with updated TB test. The resident files reviewed had the essential paperwork as per Regulations at the time of this visit, including current TB tests. Disaster preparedness: LPA Mixson reviewed the facility's emergency and disaster plan as well as the disaster training binder. LPA observed the last fire drill was conducted March 31, 2026, met the Department standards, and was logged. Infection Control: LPA Mixson observed the hand washing stations in the facility restrooms. LPA observed PPE equipment and cleaning supplies to conduct regular cleaning of the facility. LPA reviewed the facility's infection control plan and found required infection control measures met the Department requirements. Gloves were observed in residents private bathrooms. An exit interview was conducted. A copy of this report was reviewed and given to the Administrator, Nikita Desain.the state’s words, verbatim · CDSS document, Apr 10, 2026

Type of visit: Prelicensing

On April 11, 2025, Licensing Program Analyst (LPA), Venus Mixson arrived for a scheduled visit for the purpose of conducting a Pre-Licensing visit, (CHOW). LPA Mixson met with Kakani Shrikant, Administrator, introduced herself, and stated the purpose of the visit.LPA toured the location along with the Administrator and made observations following is a summary. Physical Plant: The location is a single-story facility located at 222 Washington Ave Vista CA 92084, and has nine bedrooms, seven bathrooms, a living room, dining room, and a kitchen. A backyard and front drive-in space. The Vista Fire Department approved this facility for seven non-Ambulatory, zero-Ambulatory, and six bedridden residents, on March 21, 2025. The home has a first aid kit and manual, the Administrator has received First Aid and CPR training, and the Administrator’s certificate is current, and Posted. Medications: LPA Mixson observed where medications are to be stored, locked, and inaccessible to the residents. The home is equipped with lights in the passages and stocked with emergency night lights throughout the home. The smoke and carbon monoxide detectors were observed and are operable. LPA Mixson observed two brand new fire extinguishers, charged and in the green, and obtained on 03/03/2025. The cleaning supplies were locked and inaccessible, along with the sharp objects and the Administrator informed the LPA there are no firearms on the premises. Bedrooms: Nine (9) bedrooms were observed and are large enough to allow for easy passage. The required items of furniture were discussed currently at the time of this inspection. Chair, nightstand, and sufficient lighting for future residents. Kitchen/Food: The knives were locked in a kitchen drawer, plenty of pots, pans, and other kitchen accessories. The facility has the required seven-day supply of non-perishable food items. LPA Mixson observed hygiene supplies for residents. There were no pesticides, poisons, or other toxic substances stored in any food storage or preparation area currently at the time of this inspection. (87555). Records: There is confidential storage space for personnel records at the time of this visit. (87412). Bathrooms: The (7) bathrooms floors were clean and sanitary and free of odors. Other appliances were operable, water temperature tested within regulations, and was logged. There was at least one toilet and sink for each six persons to include residents, family, and personnel. (87307), and at least one bathtub/shower for each ten persons which includes residents, family and/or live-in personnel. (87307). Administration: LPA Mixson observed emergency exiting plans and telephone numbers posted, Personal Rights, Complaint Poster, and other required documents were posted currently at the time of this visit, along with the current Administrators certification, which has an expiration date of 10/09/2025. The facility theft and loss program policy are posted (87218). Activities: There are activity supplies and equipment, including access to a variety of reading materials in the language of choice. There is an outdoor activity area equipped for outdoor use. (87219). Miscellaneous: There is a first aid kit, including sterile dressings, bandages, thermometer, and other items as required by regulations. (87465). There are laundry supplies and equipment and there is space for clean linen storage and a separate space for soiled linen. (87307). LPA Mixson observed emergency lighting supplies to include flashlights, and extra batteries. (87303). Dementia Care: There were no bodies of water on the premises currently at the time of this visit, and there are auditory devices in place to monitor exits and completely enclosed outdoor activity space with self-closing latches and gates. (87705). Inside/Outside: All doors, and passageways are clear of obstruction. There were no bodies of water on the premises, and the fireplace was covered with a screen. There was enough clean linen and hygiene items, and there was appropriate lighting in each room. LPA Mixson observed central heating and air conditioning systems, and they are operable. The Administrator dialed the land line phone number (760) 936-8887, and it was operable. Outside/Yards: Had shade and covering for shaded visits, and activities. There were no obstructions observed. The Licensee stated there were no firearms, and/or ammunition on the premises. CAB 8.0 Pre-licensing / COMP III requested and scheduled. An exit interview was conducted, a copy of this report was provided to the Administrator, Shrikant Kakani.the state’s words, verbatim · CDSS document, Apr 11, 2025