Pacific Villa, Inc

In the surveyor’s words

From the most serious findings on record at Pacific Villa, Inc, in the surveyor’s own words.

• Actual harm, isolatedF600Apr 28, 2025

  Based on observation, interview and record review the facility failed to ensure the resident was free from physical abuse and was not punched on the face multiple times by another resident for one of three sampled residents (Resident 1). The facility failed to: 1. Supervise Resident 1 and Resident 2 who were smoking on the patio and having an argument on 4/12/2025 at 3:45 a.m. as indicated in both residents' Smoking Assessment Form. 2. Assess and monitor Resident 2 when he was restless and had an escalating behavior manifested by yelling and demanding staff for a cigarette to smoke, pacing (to walk in one direction and then back again) back and forth at the facility's nursing station and hallways on 4/12/2025, from 12:00 a.m. to 3:30 a.m. 3. […]

• Actual harm, isolatedF689Apr 28, 2025

  Based on interview and record review, the facility failed to ensure the residents who were smoking on the patio were supervised and monitored for two of three sampled residents (Resident 1 and Resident 2). The facility failed to: 1. Ensure Resident 1 and Resident 2, who were assessed as needed supervision at all times, were supervised while smoking on the patio on 4/12/2025, at around 3:45 a.m. in accordance with the facility's policy and procedure titled, Smoking Policy-Residents and Resident 1's and Resident 2's Smoking Assessment Forms. 2. Ensure Resident 2's aggressive behavior was monitored and addressed on 4/12/2025. […]

• Actual harm, isolatedF684Jan 28, 2022

  A Citation [NAME] Aristoza CA 261 483.25 Quality of care Quality of care is a fundamental principle that applies to all treatment and care provided to facility residents. Based on the comprehensive assessment of a resident, the facility must ensure that residents receive treatment and care in accordance with professional standards of practice, the comprehensive person-centered care plan, and the residents' choices. Title 22: Quality of Care On 12/20/21, the Department received a complaint in regards to staff hitting Resident 1. […]

• No harm, potential for more than minimal, widespreadF880Feb 27, 2026

  Based on observation, interview and record review, the facility failed to observe infection control measures for 82 of 82 sampled residents. The facility failed to:1.Implement and document regular monitoring of water temperature for their water management plan ( a written safety plan that identifies, monitors, and controls water systems to prevent the growth of legionella bacteria[bacteria commonly found In water that can cause a severe type of pneumonia known as Legionnaires disease {[serious lung infection caused by legionella bacteria that grow in warm water}] ) designed to minimize growth and transmission of Legionella in the facility water systems.This failure had the potential of not detecting deviations in water temperature that can create conditions conducive to Legionella growth… […]

• No harm, potential for more than minimal, widespreadF814Mar 14, 2025

  Based on observation and interview, the facility failed to ensure three of three outside grey garbage dumpsters were covered. This deficient practice had a potential to harbor and attract flies, insects, mice, rats, and other animals to the garbage containers. This deficient practice also had the potential for those pests to enter the facility which could lead to the spread of infectious diseases to the residents, staff, and visitors. Findings: During a concurrent observation and interview on 3/14/2025 at 2:26 p.m., with the Director of Nursing (DON), three outside grey garbage dumpsters were observed uncovered. The DON confirmed the dumpsters were uncovered and without their lids. […]