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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197608029
Report Date: 09/24/2026
Date Signed: 09/24/2026 01:01:08 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
09/14/2026 and conducted by Evaluator Deborah Lee
COMPLAINT CONTROL NUMBER: 11-AS-20260914091614
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: 238DATE:
09/24/2026
UNANNOUNCEDTIME BEGAN:
08:53 AM
MET WITH:Suzette JohnsonTIME COMPLETED:
01:30 PM
ALLEGATION(S):
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Staff did not seek medical treatment for residents
Staff allowed resident to ingest an unsafe substance
Staff did not follow infection control guidelines to properly address a scabies outbreak
Staff did not follow reporting requirements
INVESTIGATION FINDINGS:
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On 09/24/26, the Department conducted an unannounced subsequent visit to continue investigation of the above allegations and to deliver findings. The Department met with Suzette Johnson (Administrator) and explained the purpose of the visit.

The investigation consisted of the following:
On 9/16/26, the department obtained and reviewed the following documents: Staff roster (dated 9/16/26), Resident roster (No date), staff training on infection control/Scabies (dated 3/14/26), R1’s Admission Agreement (7/8/26), R1’s discharge summary (7/13/26),R1’s service plan (dated 7/13/26), Medication order summary (dated 7/13/26), SIR (dated 9/5/26, and 7/31/26), and progress notes (dated 7/14/26).
On 9/16/26, the Department interviewed Administrator (A1), 5 staff (S1-S5), and 8 Residents (R3-R10) and an observation of the grounds.
On 9/24/26, the Department interviewed 2 residents (R1-R2)
Page 1 of 5
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Deborah Lee
LICENSING EVALUATOR SIGNATURE:

DATE: 09/24/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/24/2026
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 5
Control Number 11-AS-20260914091614
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: 09/24/2026
NARRATIVE
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The investigation revealed the following

Allegation: Staff did not seek medical treatment for residents

The detail of the complaint alleges that on 09/05/2026, the resident told a staff member they were itching, and no one would help them.

On 09/16/26, at 9:30am, the Department interviewed Administrator (A1) regarding the allegation. A1 denied the allegation stating that R1 received medical treatment. A1 stated that R1 was admitted from another facility and R1 was diagnosed with scabies however A1 made sure R1 was cleared before entering. Although R1 was cleared, he still was itching. So as a precaution A1 stated that they applied the treatment again and treated R1’s roommate. There have been no other residents who were diagnosed with scabies including this resident’s roommate.

On 9/16/26, the department reviewed an SIR (dated 9/5/26) which confirmed that R1 received medical attention.

On 9/16/26, between 10:30am and 12:00pm, the Department interviewed 5 staff members and of those interviewed 5 out of 5 stated that R1 didn’t report itching to them on 9/5/26.

On 9/24/26, the Department interviewed R1 at 10:30am who stated he had been itching badly. R1 stated that staff were very responsive when they told staff that they were itching. R1 went on to state, “they applied my cream right away.”

Based on the information gathered, there is insufficient evidence to support the allegation mentioned above; 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.

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SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Deborah Lee
LICENSING EVALUATOR SIGNATURE:

DATE: 09/24/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/24/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 11-AS-20260914091614
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: 09/24/2026
NARRATIVE
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Allegation: Staff allowed resident to ingest an unsafe substance

The detail of the complaint alleges that staff told the R1 they would stop itching if they ate mushrooms that were growing in the middle of the patio. The resident allegedly hallucinated and vomited after eating the mushrooms.

On 09/16/26, at 9:30am the department interviewed Administrator (A1) regarding the allegation. A1 denied the allegation, stating that the incident involved R1 taking it upon themself to ingest mushrooms that were growing on the property, but noted that the issue had been addressed because the mushrooms growing were removed. A1 went on to state that staff did not advise R1 to ingest mushrooms as staff are all aware they do not give any medical advice to residents.

On 9/16/26 between 10:30am and 12:00pm, the Department interviewed 5 staff members. Of those interviewed, 5 out of 5 denied the allegation stating that they have never told R1 or any other resident to ingest mushrooms to stop the itch.

On 9/16/26 and 9/24/26, between 12:00pm and 2:00pm, the Department interviewed 10 residents. Of those interviewed all 10 denied that staff had told them to ingest mushrooms for any reason. 1 out of 10 admitted that they ate the mushrooms because they wanted to and not at the urging of staff. The one resident went on to state that “their roommate ate one and nothing happened, so they thought it was okay to ingest.”

On 9/16/26, the Department toured the facility grounds and found no evidence of mushroom growth in the patio lawn. A1 and staff informed the Department that the grounds are maintained weekly and any growths such as mushrooms are removed.

Based on the information gathered, there is insufficient evidence to support the allegation mentioned above; 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.

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SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Deborah Lee
LICENSING EVALUATOR SIGNATURE:

DATE: 09/24/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/24/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 11-AS-20260914091614
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: 09/24/2026
NARRATIVE
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Allegation: Staff did not follow infection control guidelines to properly address a scabies outbreak

The detail of the complaint alleges that at the end of July, there was a scabies outbreak in the facility and allegedly, resident went to the hospital but was not treated for scabies.

On 09/16/26, at 9:30am, the department interviewed Administrator (A1) regarding the allegation. A1 denied the allegation, stating that there was no scabies outbreak at the facility at the end of July.

On 9/16/26 between 10:30am and 12:00pm, the Department interviewed 5 staff members. Of those interviewed, 5 out of 5 denied the allegation stating that there was no scabies outbreak at the end of July. 5 out of 5 stated that they have had training on infection control/scabies.

On 9/16/26 and 9/24/26, the Department interviewed 10 residents (R1-R10). All 10 residents stated that they were not aware of any scabies outbreak at the facility.

On 9/16/26, the Department obtained and reviewed staff training on infection control/Scabies (dated 3/14/26)

Based on the information gathered, there is insufficient evidence to support the allegation mentioned above; 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.

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SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Deborah Lee
LICENSING EVALUATOR SIGNATURE:

DATE: 09/24/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/24/2026
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 11-AS-20260914091614
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: 09/24/2026
NARRATIVE
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Allegation: Staff did not follow reporting requirements

The detail of the complaint alleges that did not follow reporting requirements.

On 09/16/26, at 9:30am, the department interviewed Administrator (A1) regarding the allegation. A1 denied the allegation, stating that she submitted incident report of R1’s ER. A1 provided the Department with a copy of the SIR (dated 9/5/26). The SIR was sent within the required time frame for reporting incidents.

Based on the information gathered, there is insufficient evidence to support the allegation mentioned above; 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.

Exit interview conducted with Suzette Johnson Administrator. There were no deficiencies cited during today’s visit. Copy of report provided.

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SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Deborah Lee
LICENSING EVALUATOR SIGNATURE:

DATE: 09/24/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/24/2026
LIC9099 (FAS) - (06/04)
Page: 5 of 5