197608029-4-22-2026-11-AS-UCOL-DTUMYM-20260507100147

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608029
Report Date: 04/22/2026
Date Signed: 04/22/2026 04:06:47 PM

Unsubstantiated

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
04/16/2026 and conducted by Evaluator Mario Leon

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20260416144522

FACILITY NAME:	VISTA DEL MAR SENIOR LIVING		FACILITY NUMBER:	197608029
ADMINISTRATOR:	SUZETTE JOHNSON		FACILITY TYPE:	740
ADDRESS:	3360 MAGNOLIA AVENUE		TELEPHONE:	(562) 595-1559
CITY:	LONG BEACH	STATE: CA	ZIP CODE:	90806
CAPACITY:	300	CENSUS: 242	DATE:	04/22/2026
		UNANNOUNCED	TIME BEGAN:	08:32 AM
MET WITH:	Suzette Johnson - Executive Director		TIME COMPLETED:	04:18 PM

ALLEGATION(S):

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Facility staff are not dispensing medications as prescribed
Facility staff are not keeping accurate resident records

INVESTIGATION FINDINGS:

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On 04/22/26 Licensing Program Analyst (LPA) Mario Leon conducted an initial, unannounced, complaint visit at the facility. California Department of Social Services (CDSS) was met by staff one, Suzette Johnson (S1), and the purpose of the visit was explained. S1 and CDSS toured the facility.
The investigation consisted of the following:
On 04/22/26 CDSS requested and reviewed facility documents, including medication administration records (MAR) of R2, R11-R13 and toured the facility. Between 09:30AM and 3:00PM, CDSS interviewed ten (10) residents (R1-R10) out of two-hundred forty-two (242) residents and nine (9) staff out of one-hundred twenty-one (121) staff (S1-S9).
The investigation revealed the following:
Regarding the allegation “Facility staff are not dispensing medications as prescribed”, it is being alleged that facility staff are not dispensing residents’ medication as prescribed.

Report continues, please see LIC9099-C.

Unsubstantiated

Estimated Days of Completion: 90

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Mario Leon
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)

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Control Number 11-AS-20260416144522

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 revealed that eight (8) out of ten (10) residents (R1 through R4 and R6 through R9) and all nine (S1-S9) staff have denied the allegation has taken place. Record reviews have indicated that the MARs have been marked and there are no discrepancies observed. Based on record reviews and interviews conducted, the preponderance of evidence standard has not been met. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violation occurred. Therefore, the above allegation has been Unsubstantiated.
Regarding the allegation “Facility staff are not keeping accurate resident records", it is being alleged that MARs are being backdated in order to cover up any errors. Interviews revealed that all ten (10) residents (R1-R10) and six (6) out of nine (9) staff (S1, S2, and S6 through S9) have denied the allegation has taken place. Record reviews have indicated that the MARs have been properly marked, which include whether a medication has been denied by a resident or if the medication is out of stock at the pharmacy. Based on record reviews and interviews conducted, the preponderance of evidence standard has not been met. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violation occurred. Therefore, the above allegation has been Unsubstantiated.

There have been zero (0) deficiencies cited during today's visit.

An exit interview was held with Staff one, Suzette Johnson - Executive Director (S1), and a copy of this report has been provided.

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Mario Leon
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)

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