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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306005984
Report Date: 09/24/2026
Date Signed: 09/24/2026 12:33:51 PM

Unsubstantiated


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
05/19/2026 and conducted by Evaluator Michael Tea
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20260519133831
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:122CENSUS: 51DATE:
09/24/2026
UNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Virgilio AgasTIME COMPLETED:
10:30 AM
ALLEGATION(S):
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- Resident's incontinence care needs were not met
- Staff refused to assist resident
- Staff threatened resident
- Resident was not accorded dignity
INVESTIGATION FINDINGS:
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On this day, Licensing Program Analyst (LPA) Michael Tea conducted an unannounced visit to the facility to conclude the complaint investigation and deliver the findings. LPA Tea was greeted and granted entry by Administrator Virgilio Agas, and explained the purpose of the visit.

The Department received the complaint on May 19, 2026. LPA Tea conducted the initial 10-day complaint investigation on May 29, 2026, during which residents and staff were interviewed and relevant records and information were reviewed.

It was alleged that resident's incontinence care needs were not met. The investigation revealed that Resident 1 (R1) requires staff assistance with activities of daily living. Records reviewed documented that R1 is non-ambulatory and requires assistance with toileting, bathing, transferring, and other care needs. Records also documented that R1 has bowel and bladder incontinence.
(Complaint Report continued on LIC9099C)
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Michael Tea
LICENSING EVALUATOR SIGNATURE:

DATE: 09/24/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/24/2026
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 3
Control Number 22-AS-20260519133831
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: 09/24/2026
NARRATIVE
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R1 reported an incident in which urine spilled onto the bed and the bedding was not changed for an extended period of time. R1 stated that staff placed a blue mat over the wet area instead of changing the bedding. Two out of two staff interviewed stated that staff provide residents with assistance based on their identified care needs and reported no knowledge of R1 being left in soiled bedding. The two staff further stated that staff attempted to assist R1 with continence care; however, R1 would at times refuse assistance. Staff reported that despite R1's refusal of care, staff continued to check on R1 and offer assistance. Three out of four residents interviewed stated that staff meet residents' incontinence care needs and provide assistance with changing and cleaning as needed.

It was alleged that staff refused to assist resident. R1 stated that some staff provided assistance, while other staff did not respond when assistance was requested. R1 also reported concerns regarding staff responsiveness on weekends when management was not present. Records reviewed confirmed that R1 requires staff assistance with personal care, toileting, transfers, and other activities of daily living. Four out of four staff interviewed denied refusing assistance to R1. Staff stated that attempts were made to assist R1 with personal care, continence care, and meal services; however, R1 would at times refuse the services offered. Staff reported that R1 would yell and scream when staff entered R1's room to provide assistance. Staff stated that these interactions caused staff to feel apprehensive when entering R1's room; however, staff continued to check on R1, offer assistance, and attempt to meet R1's care needs despite R1's refusals. Three out of four residents interviewed stated that staff provide assistance when needed and have not refused to help.

It was alleged that staff threatened resident. R1 reported that a staff member made a statement that caused R1 to feel threatened and uncomfortable. Two out of two staff interviewed reported no knowledge of staff threatening residents. Staff reported that interactions with R1 could be challenging due to R1 yelling and screaming when staff entered the room; however, staff stated that they continued to provide or offer assistance to R1. Three out of four residents interviewed stated that staff have not threatened residents.

It was alleged that resident was not accorded dignity. R1 reported that some staff were disrespectful and that staff laughed during an incident, which caused R1 to feel embarrassed. Two out of two staff interviewed denied making jokes about, laughing at, or otherwise treating R1 disrespectfully. Staff stated that they

(Complaint Report continued on LIC9099C)
SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Michael Tea
LICENSING EVALUATOR SIGNATURE:

DATE: 09/24/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/24/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 22-AS-20260519133831
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: 09/24/2026
NARRATIVE
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attempted to treat R1 with dignity and respect despite difficult interactions in which R1 would yell or scream at staff. Staff reported that they continued to check on R1 and offer assistance with personal care, continence care, and meals even when R1 refused services. Staff stated that they did not make jokes about or laugh at R1. Three out of four residents interviewed stated that staff treat residents with dignity and respect and reported no concerns regarding how staff communicate with or treat residents.

Based on the information obtained during the investigation, the above allegations mentioned are UNSUBSTANTIATED, meaning that although the allegations may have happened or are valid, there is not a preponderance of evidence to prove that the alleged violations occurred.

An exit interview was conducted with Administrator Virgilio Agas, and a copy of this report was provided.
SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Michael Tea
LICENSING EVALUATOR SIGNATURE:

DATE: 09/24/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/24/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 3