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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306005984
Report Date: 10/01/2026
Date Signed: 10/01/2026 12:28:33 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/25/2026 and conducted by Evaluator Hanna Fuller
COMPLAINT CONTROL NUMBER: 22-AS-20260825092606
FACILITY NAME:CIELO VISTA SENIOR LIVINGFACILITY NUMBER:
306005984
ADMINISTRATOR:VIRGILIO AGASFACILITY TYPE:
740
ADDRESS:7571 WYOMING STTELEPHONE:
(562) 569-8914
CITY:WESTMINSTERSTATE: CAZIP CODE:
92683
CAPACITY:0CENSUS: 52DATE:
10/01/2026
UNANNOUNCEDTIME BEGAN:
08:00 AM
MET WITH:Virgilio Agas TIME COMPLETED:
12:28 PM
ALLEGATION(S):
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Staff do not follow proper food storage practices
Staff do not ensure the food being served is of good quality
Staff do not ensure the facility is free of pests
Staff do not ensure the facility is clean and sanitary
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPA) Hanna Fuller and Ruth Martinez made an unannounced visit to the facility to conduct an investigation into the above mentioned complaint allegations. LPAs were greeted and granted entry by staff. LPA met with Operator Virgilio Agas and discussed the purpose of the visit.

The investigation into the facility allegations above revealed the following: It was alleged that food was being stored improperly without cross contamination in mind, as well as being stored in a fridge and freezer that are not up to regulatory temperatures. LPA reviewed pictures from Witness #1 (W1) of food being stored on the floor, with meat sitting in an open container with juices, opened sacks of sugar in the pantry, food that has not been covered in the fridge prepared for the next meal service, and freezer temperatures being at 8 degrees Fahrenheit.

Continue on LI9099C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kevin Saborit-Guasch
LICENSING EVALUATOR NAME: Hanna Fuller
LICENSING EVALUATOR SIGNATURE:

DATE: 10/01/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/01/2026
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 6
Control Number 22-AS-20260825092606
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: CIELO VISTA SENIOR LIVING
FACILITY NUMBER: 306005984
VISIT DATE: 10/01/2026
NARRATIVE
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LPA toured the facility kitchen and observed the following: LPA observed exposed raw meat on top of other items in a bowl of uncovered juices from meat. LPA toured the kitchen and observed the fridge and freezer to be at 8 degrees Fahrenheit and 45 degrees Fahrenheit. LPA observed food ready to be served in the fridge uncovered as well as food in the pantry in open packages and not sealed.

Interviews with 2 of 2 staff revealed that they agreed that staff are not following proper food storage practices Staff #1 (s1) corroborated with the pictures W1 provided LPA regarding the allegation.

Therefore the allegation has been deemed SUBSTANTIATED.

Regarding the facility allegation of Staff do not ensure the food being served is of good quality revealed the following: LPA observed pictures from W1 of expired food. LPA toured the kitchen and observed vegetables such as lettuce that appeared to be wilted with black spots and no longer of good quality.

Interviews with S1 revealed that they agreed that there was food being served not of good quality to residents. S1 corroborated with the pictures W1 provided LPA regarding the allegation.

Therefore the allegation has been deemed SUBSTANTIATED.

Regarding the facility allegation of staff do not ensure the facility is free of pests revealed the following: LPA observed pictures from W1 of dead bugs in the facility kitchen. LPA toured the kitchen and observed fruit flies in the kitchen pantry as well as dead bugs throughout the kitchen. LPA reviewed a pest control invoice from Cali-One Pest Control Inc. stating that they provided treatment on August 11, 2026, in the kitchen, storage and 5 resident rooms.

Interviews with 2 of 2 staff revealed that kitchen staff have seen bugs and observed the same bugs LPA observed and stated they saw the fruit flies and the dead bugs. S1 corroborated with the pictures W1 provided LPA regarding the allegation.

Therefore the allegation has been deemed SUBSTANTIATED.

Regarding the facility allegation of Staff do not ensure the facility is clean and sanitary revealed the following: LPA observed pictures provided from W1 of the facility kitchen floors, walls and storage bins to be dirty. LPA toured the kitchen and observed the kitchen floors, walls, fridge and freezer need cleaning of food splatter and spills. LPA observed the edges of the kitchen to have dead bugs, spills and splatters.

Continue on LIC9099C

SUPERVISORS NAME: Kevin Saborit-Guasch
LICENSING EVALUATOR NAME: Hanna Fuller
LICENSING EVALUATOR SIGNATURE:

DATE: 10/01/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/01/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 6
Control Number 22-AS-20260825092606
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: CIELO VISTA SENIOR LIVING
FACILITY NUMBER: 306005984
VISIT DATE: 10/01/2026
NARRATIVE
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Interviews with S1 revealed that they corroborated with the allegation of staff do not ensure the facility is clean and sanitary and stated that the walkways are clear but staff are not cleaning the edges or the walls based on their observation. S1 corroborated with the pictures W1 provided regarding the allegation.

Therefore the allegation has been deemed SUBSTANTIATED.

Based on information gathered, interviews conducted and tour of the facility, all the above mentioned have met the preponderance of evidence standard, therefore the above allegations are found to be SUBSTANTIATED. California Code of Regulations, Title 22 Division 6 are being cited on the attached LIC 9099D

An exit interview was conducted and a copy of this report along with LIC 9099D and appeal rights were left at the facility.

SUPERVISORS NAME: Kevin Saborit-Guasch
LICENSING EVALUATOR NAME: Hanna Fuller
LICENSING EVALUATOR SIGNATURE:

DATE: 10/01/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/01/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 6
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/25/2026 and conducted by Evaluator Hanna Fuller
COMPLAINT CONTROL NUMBER: 22-AS-20260825092606

FACILITY NAME:CIELO VISTA SENIOR LIVINGFACILITY NUMBER:
306005984
ADMINISTRATOR:VIRGILIO AGASFACILITY TYPE:
740
ADDRESS:7571 WYOMING STTELEPHONE:
(562) 569-8914
CITY:WESTMINSTERSTATE:CAZIP CODE:
92683
CAPACITY:0CENSUS: 52DATE:
10/01/2026
UNANNOUNCEDTIME BEGAN:
08:00 AM
MET WITH:Virgilio Agas TIME COMPLETED:
12:28 PM
ALLEGATION(S):
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Staff do not ensure the facility has a sufficient amount of non-perishable food
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Hanna Fuller and Ruth Martinez made an unannounced visit to the facility to conduct an investigation into the above mentioned complaint allegation. LPA was greeted and granted entry by staff. LPA met with Operator Virgilio Agas and discussed the purpose of the visit.

The investigation into the facility allegation of staff do not ensure the facility has a sufficient amount of non-perishable food revealed the following: It was alleged that the facility did not have an adequate 3-day emergency food and water supply. The allegation was not written properly.
LPA toured the facility and observed more than a 7 day non perishable food supply in the kitchen pantry.
Based on the evidence gathered, the Department finds that the allegation is unfounded. A finding that the complaint is unfounded means that the allegation is false, could not have happened, and/or is without a reasonable basis. An exit interview was conducted and a copy of this report was provided.

Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Kevin Saborit-Guasch
LICENSING EVALUATOR NAME: Hanna Fuller
LICENSING EVALUATOR SIGNATURE:

DATE: 10/01/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/01/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 6
Control Number 22-AS-20260825092606
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: CIELO VISTA SENIOR LIVING
FACILITY NUMBER: 306005984
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/01/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/02/2026
Section Cited
CCR
87555(b)(8)
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87555(b)(8) General Food Service Requirements
All food shall be of good quality...
This requirement was not met as evidence by: LPA and S1 observed vegtables to be wilting with black spots.
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This is a closed facility and is providing unlicensed care.
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This poses an immediate health and safety risk to persons in care.
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Type A
10/02/2026
Section Cited
CCR
87555(b)(9)
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87555 (b)(9) General Food Service Requirements
Procedures which protect the safety, acceptability and nutritive values of food shall be observed in food storage, preparation and service.
This requirement was not met as evidence by:
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This is a closed facility and is providing unlicensed care.
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LPA and S1 observed kitchen staff not storing food properly in the fridge and pantry. This poses an immediate health and safety risk to persons in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Kevin Saborit-Guasch
LICENSING EVALUATOR NAME: Hanna Fuller
LICENSING EVALUATOR SIGNATURE:

DATE: 10/01/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/01/2026
LIC9099 (FAS) - (06/04)
Page: 5 of 6
Control Number 22-AS-20260825092606
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: CIELO VISTA SENIOR LIVING
FACILITY NUMBER: 306005984
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/01/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/02/2026
Section Cited
CCR
87555(b)(27)
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87555 (b)(27) General food service requirement
All kitchen areas shall be kept clean and free of litter, rodents, vermin and insects.
This requirement was not met as evidence by:
LPA and S1 observed fruit flies in the pantry and dead roaches throughout the kitchen.
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This is a closed facility and is providing unlicensed care.
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This poses an immediate health and safety risk to persons in care.
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Type A
10/02/2026
Section Cited
CCR
87303(a)
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87303(a) Maintanence and Operation
The facility shall be clean, safe, sanitary and in good repair at all times....
This requirement was not met as evidence by: LPA and S1 observed the kitchen floors, walls, fridge and freezer need cleaning of food splatter and spills.
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This is a closed facility and is providing unlicensed care.
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This poses an immediate health and safety risk to persons in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Kevin Saborit-Guasch
LICENSING EVALUATOR NAME: Hanna Fuller
LICENSING EVALUATOR SIGNATURE:

DATE: 10/01/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/01/2026
LIC9099 (FAS) - (06/04)
Page: 6 of 6