Inspection Reports for Buena Vista Assisted Living
1393 S Buena Vista St, Hemet, CA 92543, CA, 92543
Back to Facility ProfileInspection Report Summary
Most inspections found no deficiencies, with the facility generally clean, well-maintained, and compliant with safety and health regulations. The most recent report from September 17, 2025, had no deficiencies and approved a capacity increase after confirming sufficient livable space and no health or safety issues. Earlier complaint investigations identified some issues with medication management, resident care, and documentation, including residents being left in soiled briefs and delayed medication administration, but these were isolated and addressed over time. A civil penalty of $500 was assessed in June 2023 for staff working without fingerprint clearance, which posed an immediate risk. Several complaint investigations were unsubstantiated, and recent reports show improvement with no deficiencies cited in the latest visits.
Deficiencies per Year
4
3
2
1
0
High
Moderate
Unclassified
Census Over Time
Census
Capacity
Inspection Report
Census: 40
Capacity: 49
Deficiencies: 0
Sep 17, 2025
Visit Reason
An unannounced case management visit was conducted due to a capacity increase request submitted by the Licensee.
Findings
The facility was found ready for the capacity increase with sufficient livable space and no health or safety issues observed. A fire clearance was granted for the increased capacity.
Report Facts
Licensed capacity: 49
Current census: 40
Fire clearance capacity: 58
Fire clearance capacity: 15
Bedridden residents allowed: 1
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Robyn Icamen | Administrator | Met with Licensing Program Analyst during the visit |
| Valerie Flores | Licensing Program Analyst | Conducted the unannounced case management visit |
| Anthony Perez | Licensing Program Manager | Named as Licensing Program Manager on the report |
Inspection Report
Annual Inspection
Census: 32
Capacity: 49
Deficiencies: 0
May 23, 2025
Visit Reason
The inspection was an unannounced annual required visit conducted to evaluate compliance with licensing requirements at the assisted living facility.
Findings
The facility was found to be clean, well-maintained, and in good repair with no deficiencies cited. Emergency preparedness and safety equipment were in place and functional, and staff and resident files were complete and up to date.
Report Facts
Licensed capacity: 49
Current census: 32
Fire extinguisher service date: Mar 31, 2025
Fire and earthquake drills date: Apr 3, 2025
Hospice waiver approved beds: 8
Ambulatory beds: 33
Non-ambulatory beds: 15
Bedridden beds: 1
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Vanessa Navarro | Clinical Care Director | Met during inspection and received exit interview |
| Debbie Palacios | Licensing Program Analyst | Conducted the inspection visit |
Inspection Report
Complaint Investigation
Census: 32
Capacity: 49
Deficiencies: 1
Jan 9, 2025
Visit Reason
The inspection was conducted as a case management deficiencies visit to issue citations for deficiencies observed during the investigation into Complaint Control No. 18-AS-20250109153636.
Findings
The facility failed to report a power outage that occurred on 2025-01-08 at 12:30 PM to the licensing department, which is a violation of reporting requirements under Title 22 Division 6 of the California Code of Regulations.
Complaint Details
The visit was complaint-related, investigating Complaint Control No. 18-AS-20250109153636. Deficiencies were cited based on observations, record review, and interviews.
Severity Breakdown
Type B: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Licensee did not report SIRs to the Department for the power outage that occurred on 1-8-25 at 12:30 PM. | Type B |
Report Facts
Capacity: 49
Census: 32
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Abdoulaye Zerbo | Licensing Program Analyst | Conducted the inspection and issued citations |
| Robyn Rebollar | Facility representative met during inspection and exit interview | |
| Rikesha Stamps | Licensing Program Manager | Supervisor and Licensing Program Manager named in report |
| Griselda Garcia | Administrator | Facility administrator listed in report |
Inspection Report
Annual Inspection
Census: 34
Capacity: 49
Deficiencies: 0
May 9, 2024
Visit Reason
An unannounced annual required visit was conducted to evaluate compliance with licensing requirements at the assisted living facility.
Findings
The facility was found to be clean, well-maintained, and in compliance with safety and health regulations. Staff files and resident records were complete and up to date. No deficiencies were cited during the inspection.
Report Facts
Staff files reviewed: 8
Resident files reviewed: 5
Food supply duration: 2
Food supply duration: 7
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Sara Martinez | Licensing Program Analyst | Conducted the inspection and authored the report |
| Vanessa Navarro | Clinical Care Director | Met with Licensing Program Analyst during inspection and received exit interview |
| Gabriella Delharo | MedTech | Met with Licensing Program Analyst at the start of the inspection |
| Griselda Garcia | Administrator | Facility administrator possessing current administrator's certificate |
Inspection Report
Complaint Investigation
Census: 38
Capacity: 49
Deficiencies: 3
Oct 23, 2023
Visit Reason
An unannounced complaint investigation visit was conducted following complaints received on 07/28/2023 regarding improper maintenance of resident records, residents being left in soiled adult briefs for extended periods, and improper disposal of discontinued medications.
Findings
The investigation substantiated that staff failed to properly maintain resident records, residents were left in soiled adult briefs especially during shift changes, and discontinued medications were not properly discarded. One allegation regarding failure to provide medications as prescribed was unsubstantiated.
Complaint Details
The complaint investigation was substantiated for allegations that staff did not ensure residents' records were properly maintained, residents were left in soiled adult briefs for extended periods, and discontinued medications were not properly discarded. The allegation that staff were not providing medications as prescribed was unsubstantiated.
Severity Breakdown
Type B: 2
Type A: 1
Deficiencies (3)
| Description | Severity |
|---|---|
| Failed to ensure that resident records were properly maintained, missing required documentation in resident files. | Type B |
| Failed to ensure residents were checked and changed as required, resulting in residents being left in soiled adult briefs for extended periods. | Type B |
| Failed to properly discard discontinued medications, with discontinued medication found in resident's medication basket. | Type A |
Report Facts
Capacity: 49
Census: 38
Deficiencies cited: 3
Plan of Correction Due Dates: 2023
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Javina George | Licensing Program Analyst | Conducted the complaint investigation and authored the report |
| Joel Esquivel | Licensing Program Manager | Named as Licensing Program Manager overseeing the investigation |
| Jazmond D Harris | Licensing Program Manager | Named as Licensing Program Manager overseeing the investigation |
| Robin Rebollar-Icamen | Administrator | Facility Administrator met during investigation and named in findings |
| Vanessa | Business Office Manager/Med Tech | Provided information regarding resident care and medication disposal |
Inspection Report
Complaint Investigation
Census: 35
Capacity: 49
Deficiencies: 1
Jun 20, 2023
Visit Reason
The inspection was an unannounced complaint investigation visit conducted in response to allegations that staff were not providing medications as prescribed to residents and that staff did not respond to residents' calls for assistance in a timely manner.
Findings
The allegation that staff did not provide medications as prescribed was substantiated due to staff taking medication room keys home, causing delayed medication administration to Resident #1. The allegation that staff did not respond timely to call lights was unsubstantiated based on observations and interviews, including that the call light cord was not fully pulled by the resident, preventing staff notification.
Complaint Details
The complaint investigation was substantiated for the allegation that staff did not provide medications as prescribed, with evidence that Resident #1 did not receive their 2:00am medication on time because staff took medication room keys home. The allegation that staff did not respond to call lights in a timely manner was unsubstantiated.
Deficiencies (1)
| Description |
|---|
| Failure to provide medications as prescribed due to staff taking medication room keys home, resulting in delayed medication administration to Resident #1. |
Report Facts
Capacity: 49
Census: 35
Deficiency Type: 1
Plan of Correction Due Date: Jul 4, 2023
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Javina George | Licensing Program Analyst | Conducted the complaint investigation and authored the report |
| Joel Esquivel | Licensing Program Manager | Named as Licensing Program Manager overseeing the investigation |
| Bernadette Best | Administrator | Facility Administrator met during the investigation and named in findings |
Inspection Report
Complaint Investigation
Census: 35
Capacity: 49
Deficiencies: 1
Jun 20, 2023
Visit Reason
An unannounced case management deficiencies visit was conducted to investigate fingerprint clearance compliance of staff and administrator at the facility.
Findings
The Licensing Program Analyst observed that the administrator, Bernadette Lynch-Best, was not associated with the facility due to inactive fingerprints, and Staff 1 was working without fingerprint clearance, posing an immediate risk to residents. A deficiency was issued and a civil penalty of $500 was assessed.
Complaint Details
The visit was complaint-related due to concerns about fingerprint clearance. The deficiency was substantiated with evidence that staff and the administrator lacked proper fingerprint clearance.
Severity Breakdown
Type A: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Staff working and providing care at the facility without fingerprint clearance, posing immediate health, safety, and personal rights risk to persons in care. | Type A |
Report Facts
Civil penalty amount: 500
Deficiencies cited: 1
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Bernadette Lynch-Best | Administrator | Observed to have inactive fingerprints and not associated with the facility |
| Javina George | Licensing Program Analyst | Conducted the unannounced case management deficiencies visit |
| Joel Esquivel | Licensing Program Manager | Supervisor overseeing the inspection |
Inspection Report
Complaint Investigation
Census: 38
Capacity: 49
Deficiencies: 0
Nov 29, 2022
Visit Reason
Unannounced visit/investigation of a complaint received on 07/25/2022 regarding allegations of resident mistreatment and care concerns at Buena Vista Assisted Living Facility.
Findings
All allegations including resident molestation, unmet care needs, rough handling by staff, and residents being locked in rooms were investigated and found to be unsubstantiated due to lack of evidence or information.
Complaint Details
The complaint involved multiple allegations: resident molestation by another resident, staff not meeting care needs, rough handling of residents by staff, and residents being locked in their rooms. After interviews with residents, staff, family members, and review of incident reports and physical inspection, all allegations were found unsubstantiated.
Report Facts
Facility capacity: 49
Census: 38
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Crystal Colvin | Licensing Program Analyst | Conducted the complaint investigation and interviews |
| Joel Esquivel | Licensing Program Manager | Named in report as Licensing Program Manager |
| Mariel Hernandez | MedTech | Met with Licensing Program Analyst during investigation |
Inspection Report
Census: 35
Capacity: 49
Deficiencies: 0
Sep 12, 2022
Visit Reason
The visit was an unannounced case management health and safety visit in reference to repopulating the facility after evacuation.
Findings
No imminent health or safety concerns were observed. The facility was found to have sufficient staff, utilities, food, and medication supplies. No deficiencies were cited during the visit.
Report Facts
Residents present: 35
Total capacity: 49
Food supply duration: 2
Food supply duration: 7
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Jesse Gardner | Licensing Program Analyst | Conducted the case management health and safety visit |
| Griselda Garcia | Administrator | Facility administrator met with Licensing Program Analyst during the visit |
Inspection Report
Complaint Investigation
Census: 38
Capacity: 49
Deficiencies: 2
Jul 26, 2022
Visit Reason
An unannounced complaint investigation was conducted in response to allegations that staff did not follow Covid-19 safety protocols and that the facility did not ensure it was free from pests.
Findings
The investigation substantiated both allegations: the facility failed to obtain a negative COVID-19 test prior to a resident's admission, contributing to a COVID-19 outbreak, and the facility had an ongoing ant infestation in a resident's room.
Complaint Details
The complaint was substantiated based on evidence that staff did not follow COVID-19 safety protocols and the facility did not maintain pest-free conditions. The preponderance of evidence standard was met.
Severity Breakdown
Type A: 1
Type B: 1
Deficiencies (2)
| Description | Severity |
|---|---|
| Failure to obtain a negative COVID-19 test prior to resident admission, posing an immediate health risk due to a subsequent COVID-19 outbreak. | Type A |
| Failure to ensure the facility was free from pests, evidenced by an ongoing ant infestation in a resident's room. | Type B |
Report Facts
Capacity: 49
Census: 38
Plan of Correction Due Date: Jul 27, 2022
Plan of Correction Due Date: Aug 9, 2022
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Crystal Colvin | Licensing Program Analyst | Conducted the complaint investigation and documented findings |
| Joel Esquivel | Licensing Program Manager | Oversaw the complaint investigation report |
| Griselda T. Garcia | Administrator | Facility administrator met during investigation and named in findings |
Inspection Report
Complaint Investigation
Census: 38
Capacity: 49
Deficiencies: 0
Jul 26, 2022
Visit Reason
The inspection visit was conducted as an unannounced investigation of complaint #18-AS-20220725131214 at the facility.
Findings
The Licensing Program Analyst observed that the facility had working utilities, adequate staffing, and sufficient food supplies. No immediate health and safety concerns were noted during the inspection.
Complaint Details
Investigation of complaint #18-AS-20220725131214; no immediate health and safety concerns were found.
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Griselda T. Garcia | Administrator | Met with Licensing Program Analyst during complaint investigation. |
| Crystal Colvin | Licensing Program Analyst | Conducted the unannounced complaint investigation visit. |
| Joel Esquivel | Licensing Program Manager | Named in the report header. |
Inspection Report
Annual Inspection
Census: 38
Capacity: 49
Deficiencies: 2
Jul 26, 2022
Visit Reason
The inspection was an unannounced annual inspection limited to infection control practices at the assisted living facility.
Findings
The facility was found to be generally compliant with COVID-19 infection control best practices, including availability of hand sanitizer and PPE supplies. However, the facility lacked a current Infection Control Plan and staff had not been fit tested for N95 masks. Additionally, deficiencies were cited for failure to properly report a COVID-19 outbreak and for past due licensing fees.
Severity Breakdown
Type A: 1
Type B: 1
Deficiencies (2)
| Description | Severity |
|---|---|
| Failure to comply with reporting requirements for a COVID-19 outbreak, including lack of a written incident report. | Type A |
| Failure to pay annual licensing fees for 2022, which were past due in the amount of $1,238.00. | Type B |
Report Facts
Licensing fees past due: 1238
Facility capacity: 49
Census: 38
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Griselda T. Garcia | Administrator | Named in relation to infection control practices and reporting deficiencies |
Inspection Report
Annual Inspection
Census: 38
Capacity: 49
Deficiencies: 1
May 25, 2021
Visit Reason
The inspection visit was an unannounced annual inspection limited to infection control, conducted to assess the facility's compliance with COVID-19 best practices and mitigation measures.
Findings
The facility was found to be successfully incorporating numerous aspects of its COVID-19 Mitigation Plan, including availability of hand sanitizer, stocked bathrooms, and posted infection control signage. Staff have not been fit tested for N95 masks, but no deficiency was issued due to no current COVID-19 positive residents and other precautions in place.
Deficiencies (1)
| Description |
|---|
| Staff have not been fit tested for N95 masks. |
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Dolly Newcomb | Administrator | Met with Licensing Program Analyst during inspection and discussed infection control practices. |
| Jennifer Semin | Licensing Program Analyst | Conducted the inspection and issued a Technical Assistance Advisory Note. |
| Karen Clemons | Licensing Program Manager | Named as Licensing Program Manager on the report. |
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