197608029-8-19-2026-11-AS-PMAA-DXSN4K-20260910100804

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608029
Report Date: 08/19/2026
Date Signed: 08/19/2026 04:40:22 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
08/13/2026 and conducted by Evaluator Antonine Richard

COMPLAINT CONTROL NUMBER: 11-AS-20260813161607

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: 248	DATE:	08/19/2026
		UNANNOUNCED	TIME BEGAN:	08:29 AM
MET WITH:	Suzette Johnson		TIME COMPLETED:	05:00 PM

ALLEGATION(S):

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Staff did not prevent a resident from causing harm to another resident.

INVESTIGATION FINDINGS:

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On August 19, 2026, Licensing Program Analyst (LPA) Antonine Richard conducted an initial visit to gather information regarding the above allegation. LPA Richard met with Executive Director Suzette Johnson and explained the purpose of the visit.

The investigation consisted of the following: On 08/19/2026, LPA Richard reviewed and obtained the following documents: Staff and Resident Roster and Unusual Incident Report (dated 08/12/2026/UIR). The investigation also included documents for residents (R1-R2), the admission agreement, and the physician report. LPA interviewed ten residents (R1-R10) and three staff members (S1-S3), including a Licensed Vocational Nurse (LVN).

Report continued on LIC9099C.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Antonine Richard
LICENSING EVALUATOR SIGNATURE:	DATE: 08/19/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/19/2026

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-20260813161607

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: 08/19/2026

NARRATIVE

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Allegation: Staff did not prevent a resident from causing harm to another resident.

The complaint alleged that on August 12, 2026, at 8:30 p.m., R1's roommate attempted to hit R1 while R1 was lying in bed. On August 19, 2026, LPA Richard interviewed the facility administrator, who denied the allegation. The administrator (A1) explained that R1 had recently moved into the facility. On the night of the incident, R2's roommate asked R1 to turn off the TV because it was late (around 8:55 p.m.), and R1 refused.

At that moment, a staff member passing by the room heard the argument and called the Licensed Vocational Nurse (LVN) to intervene, which the LVN did. At the same time, LPA interviewed the LVN on August 19, 2026. The LVN reported that upon arrival in the residents' room, both R1 and R2 were lying on their beds and stated they were fine. The LVN asked whether either wanted to move to another room by the next morning, but both declined. On August 13, 2026, R2 requested a room change and was subsequently reassigned.

During the investigation on August 19, 2026, LPA interviewed three staff members (S1-S3), all of whom denied the allegations. They stated that they supervise residents in common areas, provide activities to keep residents engaged, and intervene when they observe any issues.

Additionally, LPA interviewed ten residents (R1-R10) that day. Eight of the ten residents reported that they had never experienced a conflict with their roommate and were trying to get along.

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Antonine Richard
LICENSING EVALUATOR SIGNATURE:	DATE: 08/19/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/19/2026

LIC9099 (FAS) - (06/04)

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Control Number 11-AS-20260813161607

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: 08/19/2026

NARRATIVE

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At the same time, LPA also interviewed R1 and R2. Both stated that they had been fined; there were no physical altercations.

During the facility inspection, LPA observed staff in common areas supervising residents and ensuring they were available to assist them.

During the record review, LPA received and reviewed an Unusual Incident/Injury Report dated 08/12/2026, which the facility sent to the Community Care Licensing Department (CCLD), indicating that Resident R1 had a verbal altercation with Resident R2 and that there was no physical altercation.

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

No deficiencies were cited.

An exit interview was conducted. A copy of this report was provided to the Administrator Suzette Johnson.

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Antonine Richard
LICENSING EVALUATOR SIGNATURE:	DATE: 08/19/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/19/2026

LIC9099 (FAS) - (06/04)

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