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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197608029
Report Date: 04/22/2026
Date Signed: 04/22/2026 04:31:12 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
This is an official report of an unannounced visit/investigation of a complaint received in our office on
02/18/2026 and conducted by Evaluator Jose Anguiano
PUBLIC
COMPLAINT CONTROL NUMBER: 11-AS-20260218190506
FACILITY NAME:VISTA DEL MAR SENIOR LIVINGFACILITY NUMBER:
197608029
ADMINISTRATOR:SUZETTE JOHNSONFACILITY TYPE:
740
ADDRESS:3360 MAGNOLIA AVENUETELEPHONE:
(562) 595-1559
CITY:LONG BEACHSTATE: CAZIP CODE:
90806
CAPACITY:300CENSUS: 242DATE:
04/22/2026
UNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Suzette JohnsonTIME COMPLETED:
04:50 PM
ALLEGATION(S):
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Lack of care and supervision.
INVESTIGATION FINDINGS:
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On 04/22/2026, at approximately 1:00 PM, Licensing Program Analyst (LPA) Jose Anguiano conducted a subsequent visit to deliver findings. LPA met with the Administrator Suzette Johnson. This report supersedes the previous report issued on 03/19/2026. The purpose of this report is to provide additional information; the findings have not changed and remain SUBSTANTIATED.
The investigation consisted of the following: On 04/22/2026, The Department toured the memory care unit. Reviewed records including the personnel report, staff roster, February 2026 memory care staffing schedule, grouping sheet, incident reports, resident progress notes, and facility procedures. Conducted interviews with six staff (S1–S6) and seven family witnesses (W1–W7). On 04/22/2026, additional interviews with five residents (R1–R5) were conducted.
The investigation revealed the following regarding the allegation: “Lack of care and supervision.” It is alleged that facility staff failed to provide adequate supervision, resulting in a resident sustaining an unwitnessed fall during the night with no staff awareness of when or how the fall occurred.
Please see (LIC9099-C) for report continuation.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Jose Anguiano
LICENSING EVALUATOR SIGNATURE:

DATE: 04/22/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/22/2026
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 11-AS-20260218190506
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
FACILITY NAME: VISTA DEL MAR SENIOR LIVING
FACILITY NUMBER: 197608029
VISIT DATE: 04/22/2026
NARRATIVE
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Interviews conducted revealed the following: Staff (S1) reported the incident was unwitnessed and discovered at approximately 6:00 AM during morning rounds. Staff (S2–S3) reported the resident was found with a bump on the head at approximately 5:30 AM. Staff (S1–S3) reported they were unable to determine when or where the fall occurred. Staff (S1) reported four staff were scheduled for the overnight shift; however, three staff were present due to staffing changes. Staff (S2–S3) confirmed three staff were assigned to the overnight shift. Staff (S6) reported that three staff provide care for approximately 35 memory care residents during the overnight shift. Witnesses (W1–W5) reported concerns regarding night supervision, staffing levels, and prior unwitnessed falls. Witnesses (W6–W7) reported no concerns. Of the residents interviewed, (2) out of (5) residents reported staff do not check on them during the night or do not recall staff presence. (3) out of (5) residents were unable to confirm whether staff conducted nighttime checks. (4) out of (5) residents reported prior falls or being on the floor, including (1) resident who reported a fall that was not reported to staff. (6) out of (6) residents were not able to provide interviews due to their medical conditions. Observations revealed the following: LPA toured the memory care unit and observed multiple hallways and resident rooms extending in different directions, not visible from a single central area. The unit houses approximately 35 residents, including residents requiring incontinence care. Staff reported grouping residents in a common area for visibility. At the time of the visit, approximately 4–5 staff were observed present with residents. Records review revealed the following: Review of the February 2026 staffing schedule confirmed that three staff, including registry staff, were assigned to the overnight shift on 02/13/2026–02/14/2026. Incident reports and progress notes confirmed that (R1) sustained an injury consistent with a fall that occurred overnight. Documentation did not identify the time or circumstances of the fall. Progress notes dated 02/14/2026 document that caregivers reported the injury in the morning and indicated limited information was available from the overnight shift regarding the incident. Review of incident reports and progress notes dated 02/06/2026, 02/10/2026, and 02/14/2026 document residents were found on the floor with injuries during morning hours, with no documentation identifying when or how the falls occurred. Resident records indicate that all 35 out of 35 memory care residents require incontinence care and supervision due to behaviors such as wandering/exit seeking behaviors.
Based on the evidence gathered, including interviews, observations, and records reviewed, the preponderance of evidence standard has been met. Therefore, the allegation is SUBSTANTIATED. This is a violation of California Code of Regulations, Title 22, Division 6, Chapter 8, Section 87411(a), which requires sufficient staff to meet resident care and supervision needs. A citation is issued on the attached LIC 9099-D. An exit interview was conducted, and a copy of this report and appeal rights were provided to the Administrator.
SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Jose Anguiano
LICENSING EVALUATOR SIGNATURE:

DATE: 04/22/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/22/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 11-AS-20260218190506
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

FACILITY NAME: VISTA DEL MAR SENIOR LIVING
FACILITY NUMBER: 197608029
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/22/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/26/2026
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.
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Licensee agreed to submit a plan of correction to LPA Jose Anguiano at Jose.Anguiano@dss.ca.gov by due date.
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This requirement is not met as evidenced by:
Based on interviews, observations, and records review, the licensee failed to ensure sufficient staffing to meet the needs of 35 residents during overnight hours. Records review confirmed that three staff were assigned to provide care during the overnight shift. Incident reports and progress notes document a pattern of residents found with injuries during morning hours, with no documentation identifying when or how the incidents occurred. This posed a potential 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.
SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Jose Anguiano
LICENSING EVALUATOR SIGNATURE:

DATE: 04/22/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/22/2026
LIC9099 (FAS) - (06/04)
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