197608029-7-26-2021-11-AS-JHAD-C6ALKW-20210827085012

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608029
Report Date: 07/26/2021
Date Signed: 07/26/2021 10:51:49 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/13/2021 and conducted by Evaluator Jose Calderon

COMPLAINT CONTROL NUMBER: 11-AS-20210713143552

FACILITY NAME:	VISTA DEL MAR SENIOR LIVING		FACILITY NUMBER:	197608029
ADMINISTRATOR:	BRAD DEHAAN		FACILITY TYPE:	740
ADDRESS:	3360 MAGNOLIA AVENUE		TELEPHONE:	(562) 595-1559
CITY:	LONG BEACH	STATE: CA	ZIP CODE:	90806
CAPACITY:	300	CENSUS: 178	DATE:	07/26/2021
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	ADMINISTRATOR BRAD DEJAAN		TIME COMPLETED:	11:00 AM

ALLEGATION(S):

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Resident wasn’t provided medical care in a timely manner

INVESTIGATION FINDINGS:

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On 07/26/2021 around 10:00 am Licensing Program Analyst (LPA) Jose Calderon initiated a complaint investigation to deliver the investigation findings for the allegation listed above. LPA Calderon met with Administrator Brad DeHaan, Administrator and the purpose of the visit was explained.

The Investigation consisted of the following: On 07/13/2021 LPA Calderon interviewed witness for the complaint. On 07/22/2021 LPA Calderon interviewed Administrator Brad DeHaan and conducted a tour of the physical plant. LPA Calderon obtained copies of Staff and Resident rosters, Resident #1’s record (Needs and Service Plan, Physicians Report and pest control documentation for the facility. On 07/22/2021 LPA Calderon interviewed staff S1-S6 regarding complaint and on 07/22/2021 LPA Calderon interviewed R1-R3 for complaint. On 07/23/2021 LPA Calderon interviewed facility doctor for complaint.

The investigation revealed the following:

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Jose Calderon	TELEPHONE: (323) 213-1153
LICENSING EVALUATOR SIGNATURE:	DATE: 07/26/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/26/2021

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 11-AS-20210713143552

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: VISTA DEL MAR SENIOR LIVING	FACILITY NUMBER: 197608029
	VISIT DATE: 07/26/2021

NARRATIVE

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Allegation: Resident wasn’t provided medical care in a timely manner
It is alleged that Resident wasn’t provided medical care in a timely manner. On 07/13/2021 LPA Calderon interviewed witness for the complaint and confirmed R1 had an rash on the chest area and believes R1 has scabies, and witness has taken R1 to see a dermatologist and will have test results within 2 weeks. On 07/22/2021 LPA Calderon interviewed S1 who confirms R1 does have a rash on the chest area and when they were made aware of the rash by his caregivers, they treated the rash with ointment for rash and scabies. S1 confirms this was done quickly and they informed R1 family by phone. On 07/22/2021 LPA Calderon interviewed S2-S6 and all confirm that medical care was given to R1 on time and when the rash first showed up on R1 chest. On 07/22/2021 LPA Calderon interviewed R1-R3 all have some cognitive issues/dementia and they were unable to answer LPAs questions fully. All were able to communicate they are happy living in the facility. On 07/23/2021 LPA Calderon received and reviewed facility paperwork: Physician's report which indicated R1 primary diagnosis is dementia. Cleaning schedule 2021, extensive cleaning schedule for facility, Reviewed Orkin paperwork, service 7/22/2021 inspected for bugs none were found, treated new room 290 to confirm no bugs and no scabies found. On 07/23/2021 interviewed facility doctor and confirmed R1 had a rash, unclear at this time if scabies or not, but R1 was treated when rash was first noticed by caregivers.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated.

An exit interview was conducted with Administrator Brad DeHaan, and a hard copy was provided.

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Jose Calderon	TELEPHONE: (323) 213-1153
LICENSING EVALUATOR SIGNATURE:	DATE: 07/26/2021

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/26/2021

LIC9099 (FAS) - (06/04)

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