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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 315920292
Report Date: 08/05/2026
Date Signed: 08/05/2026 10:50:06 AM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 2525 NATOMAS PARK DR STE 270
SACRAMENTO, CA 95833
This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/22/2026 and conducted by Evaluator Bethany Mirlohi
COMPLAINT CONTROL NUMBER: 59-AS-20260722085555
FACILITY NAME:VISTA ROSEVILLE SENIOR LIVINGFACILITY NUMBER:
315920292
ADMINISTRATOR:KIMBRO, SHERIFACILITY TYPE:
740
ADDRESS:100 STERLING COURTTELEPHONE:
(916) 786-7200
CITY:ROSEVILLESTATE: CAZIP CODE:
95661
CAPACITY:128CENSUS: 105DATE:
08/05/2026
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Anelisa Fusneica, Assistant AdministratorTIME COMPLETED:
11:00 AM
ALLEGATION(S):
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Staff do not respond to resident's call for assistance in a timely manner
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Bethany Mirlohi arrived unannounced to complete investigation into allegation listed above. LPA met with assistant administrator Anelisa Fusneica during today's inspection.

LPA investigated allegation, "Staff do not respond to resident's call for assistance in a timely manner." LPA interviewed staff, residents, and reviewed facility documentation. Relevant party stated R1 is waiting up 2 hours to be transfer to and from bed to wheelchair or to receive continence care. LPA interviewed R1 in which they stated they are waiting 40 or more minutes to get help from caregivers. R1 stated that in July 2026 a caregiver never answered their call light and R1 missed lunch and remained in bed until the PM shift. LPA reviewed R1's call light log from May 2026 to July 2026 and observed R1 waited over 40 minutes 51 times. LPA interviewed caregivers in which they stated they are having a hard time meeting residents care needs with their current staffing levels. Due to the information gathered, LPA finds allegation to be SUBSTANTIATED.
Deficiencies cited on 9099-D. Copy of report and appeal rights provided.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Troy Ordonez
LICENSING EVALUATOR NAME: Bethany Mirlohi
LICENSING EVALUATOR SIGNATURE:

DATE: 08/05/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/05/2026
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 59-AS-20260722085555
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 2525 NATOMAS PARK DR STE 270
SACRAMENTO, CA 95833

FACILITY NAME: VISTA ROSEVILLE SENIOR LIVING
FACILITY NUMBER: 315920292
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/05/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/12/2026
Section Cited
CCR
87411(a)
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87411 Personnel Requirements - General. (a) Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs. In facilities licensed for sixteen or more, sufficient support staff shall be employed to ensure provision of personal assistance and care as required in Section 87608, Postural Supports. Additional staff shall be employed as necessary to perform office work, cooking, house cleaning, laundering, and maintenance of buildings, equipment and grounds. The licensing agency may require any facility to provide additional staff whenever it determines through documentation that the needs of the particular residents, the extent of services provided, or the physical arrangements of the facility require such additional staff for the provision of adequate services.
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Administrator to send into LPA a plan of how they are going to met the needs of the residents with sufficient staffing. Plan to be sent into LPA by 8/12/26.
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This requirement is not met as evidenced by: Based on interviews and record reviews licensee is unable to met the needs of the residents in care which poses a potential health and safety risk to residents 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: Troy Ordonez
LICENSING EVALUATOR NAME: Bethany Mirlohi
LICENSING EVALUATOR SIGNATURE:

DATE: 08/05/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/05/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 3
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO NORTH ASC, 2525 NATOMAS PARK DR STE 270
SACRAMENTO, CA 95833
This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/22/2026 and conducted by Evaluator Bethany Mirlohi
COMPLAINT CONTROL NUMBER: 59-AS-20260722085555

FACILITY NAME:VISTA ROSEVILLE SENIOR LIVINGFACILITY NUMBER:
315920292
ADMINISTRATOR:KIMBRO, SHERIFACILITY TYPE:
740
ADDRESS:100 STERLING COURTTELEPHONE:
(916) 786-7200
CITY:ROSEVILLESTATE:CAZIP CODE:
95661
CAPACITY:128CENSUS: 105DATE:
08/05/2026
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Anelisa Fusneica, Assistant AdministratorTIME COMPLETED:
11:00 AM
ALLEGATION(S):
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Staff left resident in soiled clothing
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Bethany Mirlohi arrived unannounced to complete investigation into allegation listed above. LPA met with assistant administrator Anelisa Fusneica during today's inspection.

LPA investigated allegation, "Staff left resident in soiled clothing". LPA interviewed staff, relevant party, resident and reviewed facility documentation. Relevant party stated R1 is waiting up to 2 hours to receive continence care from care staff. LPA interviewed R1 and they stated that in the past they have had to wait long periods of time to receive continence care but currently it s not an issue. LPA interviewed caregivers in which they stated they are having a hard time meeting residents care needs with their current staffing levels. Due to the information gathered, R1 stated in the past she has been left in soiled clothing but recently it has not been an issue, LPA finds allegation to be UNSUBSTANTIATED.

Exit interview was conducted and copy of report provided.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Troy Ordonez
LICENSING EVALUATOR NAME: Bethany Mirlohi
LICENSING EVALUATOR SIGNATURE:

DATE: 08/05/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/05/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 3