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Inspection visit

Incident investigation

VISTA ROSA ELDER CARELicense 4058023061 citation on this visit
1 citation recorded

Inspector’s narrative

What the inspector wrote

Licensing Program Analyst (LPA) De Leon conducted a case management-incident visit to the facility above. LPA met with back up Administrator Jessica Bailey and explained the purpose of the visit. Community Care Licensing (CCL) received a self reported incident report from the facility dated 12/10/2025. LPA De Leon received a telephone call from Administrator Rachelle Tellez on 12/10/2025 reporting resident 1(R1) and resident 2 (R2) had an incident where a personal trainer contracted by resident 2(R2) was involved in kicking R1's walker back so R1 could not push R1's walker into R2's wheelchair. On 02/05/2026 Administrator Rachelle Tellez sent LPA De Leon a copy of the video surveillance she had sent to LTCO of the incident. LPA De Leon reviewed the video surveillance and it was found that the personal trainer of R2 was left alone with both R1 and R2 in a common area of the facility. The personal trainer as a contractor hired by R2 was not able to be left alone with R1 and no staffing of the facility was present at the exact time of the incident, staffing immediately came into the common area as soon as the incident had ended. The personal trainer that was contracted by R2 was not on the facility approved Guardian roster for CCL and therefore should not have been left alone with R1 in care without being associated to the facility Guardian roster. Exit interview conducted, deficiency cited, civil penalty assessed, copy of report and appeal rights printed for Administrator.

Citations

2 citations recorded*CCLD

What does Type A vs Type B mean?

Type A. Serious citation. Imminent or substantial risk to children. The regulator requires corrective action immediately and may impose a civil penalty.

Type B. Lower-severity citation. Corrective action required, no imminent risk. The regulator monitors compliance on the next visit.

  • 87705(d)Type A

    Auditory exit monitoring for elopement risk

    (d) The licensee shall ensure that the facility has an auditory device or other staff alert feature to monitor exits on exterior doors and perimeter fence gates accessible to those residents who may be at risk for elopement, as defined in Section 87101, Definitions. This requirement was not met evidenced by: Based on records the Licensee did not comply with the regulation above, R1 was able to elope from the facility property and sustained a scrape on R1's elbow which possess a immediate health, safety and personal rights risk to residents in care.

  • 1569.17(b)(2)(C)Type A

    (b)...(2) The following persons are exempt from requirements applicable under paragraph (1):(C) A third-party contractor retained by the facility if the contractor is not left alone with clients in care. This requirement was not met as evidenced by: Based on video surveillance the Licenesee did not comply witht the regulation above the personal trianer higher by R2 did not have a clearance to be left alone with R1 which possess an immediate health and saefty risk for residnets in care.

FAQ · About this visit

Common questions about this visit

What happened during the February 27, 2026 inspection of VISTA ROSA ELDER CARE?

This was an other inspection of VISTA ROSA ELDER CARE on February 27, 2026. 1 citation were issued: 1 Type A (serious).

Were any citations issued to VISTA ROSA ELDER CARE on February 27, 2026?

Yes, 1 citation was issued (1 Type A, 0 Type B). The first citation was for: "(d) The licensee shall ensure that the facility has an auditory device or other staff alert feature to monitor exits on ..."

What type of inspection was this?

This was an other inspection. other inspections are conducted by CCLD as part of their licensing oversight.

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Data from CCLD public records. Last updated . If you believe any information is inaccurate, report it here.