197608029-8-12-2020-11-AS-MCAA-BSWR5W-20200828124346

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608029
Report Date: 08/12/2020
Date Signed: 08/12/2020 02:58:47 PM

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
06/10/2020 and conducted by Evaluator Jade Jordan

COMPLAINT CONTROL NUMBER: 11-AS-20200610151452

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:	DATE:	08/12/2020
		UNANNOUNCED	TIME BEGAN:	02:30 PM
MET WITH:	Brad Deehan Administrator		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

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Facility does not provide comfortable water temperature for residents while in care
Facility drinking water is not properly maintained

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Jade Jordan, conducted a subsequent visit to conclude the initial 10-day complaint from 06/18/20. Due to the situation surrounding the Coronavirus Disease 2019 (COVID-19), and to implement mitigation measures, today’s complaint investigation was conducted telephonically with Brad Deehan, the facility administrator.

During the initial visit the investigation consisted of the following: Review of resident records, interviews conducted with facility staff, reporting party, residents, and copies obtained of files pertinent to the allegation.

Based on the Allegation: Facility does not provide comfortable water temperature for residents while in care.

The Investigation revealed the following:

(Copy of report Continued on 9099C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Michael Cava	TELEPHONE: (323) 400-7397
LICENSING EVALUATOR NAME: Jade Jordan	TELEPHONE: (650) 388-2300
LICENSING EVALUATOR SIGNATURE:	DATE: 08/12/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/12/2020

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 4

Control Number 11-AS-20200610151452

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: 08/12/2020

NARRATIVE

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RP, who is R1 indicated that it was hard for her to take a bath due to her not knowing what the water temperature would be. It could be warm, then go cold. LPA Jordan Interviewed R1 and asked her about the comfort of water temperature in her room. R1 stated that they fixed the problem last week but could not recall the date that the water went cold. R1 stated that it was recent, and remembers that she was leaving the facility with her son, to go somewhere, but couldn’t recall the date. R1 states that she has had trouble remembering things, and usually writes things down in a journal. R1 referred to journal for date but could not recall.

LPA asked R1 if she had left the facility recently since the Covid19 Pandemic. R1 stated that she has not left the facility during the pandemic. Review of Facility records show that R1 left the facility with her son (POA) around March/ April of 2020, Due to Public Health Emergency, because the facility was not allowing personal visitors, but returned to the facility April 28^th, 2020. The facility has been on Quarantine lock down since early March.

During review of R1’s Physicians report it was shown that R1 currently suffers from a Dementia Diagnosis.

The facility self reported a was cited for a previous water issue that was fixed in January 2020. LPA conducted Interviews with other residents within the facility, and the consensus was that, the water temperature within the facility has been hot, and functional, after the January 2020 occurrence. LPA virtually checked water temperature in several rooms with assistance of staff, and the water measured within title 22 regulations of 105d-120d.

Based on the department's investigation, Review of Physicians report, Needs and Services, and resident statement. It was determined that Although the allegation may have happened or is valid, there is not preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated.

SUPERVISOR'S NAME: Michael Cava	TELEPHONE: (323) 400-7397
LICENSING EVALUATOR NAME: Jade Jordan	TELEPHONE: (650) 388-2300
LICENSING EVALUATOR SIGNATURE:	DATE: 08/12/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/12/2020

LIC9099 (FAS) - (06/04)

Page: 4 of 4

Control Number 11-AS-20200610151452

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: 08/12/2020

NARRATIVE

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Based on the Allegation: Facility drinking water is not properly maintained

The Investigation revealed the following:

RP stated that sometimes the water used from her private bedroom sink spoils her smoothies. LPA asked if RP had used water from the bathroom sink. RP states no, that in her room she has a an ionized aklaline filtration system, she had installed,( not provided by the facility). LPA asked RP if she had requested drinking water from the facility kitchen, or from drinking fountain. RP said she had not done so. Rp asked if it is only the water from her private sink that tastes spoiled. Rp stated yes. LPA Observed an ionizer attached to bedroom sink, asked RP if her Ionizer needed maintenance work done. RP stated she could not recall if she has ever had maintenance done, but said that the machine tells you when it is needed. During the virtual tour LPA Observed in R1's room the Ionizer hooked up to the sink and observed several settings. It showed pH2.5 with a picture of hands labeled sanitary, ( Strong Acidic), pH6.0 with a picture of a woman face, labelled care (beauty), pH7.0 Medication formula picture of a baby bottle push button Clean Water, Drink3 with a pH9.5, Drink2 pH9.0, Drink1 pH8.5. All Drinking water was labelled "kangen".

Interviews were conducted with residents, and staff. All generally stated that they have no issue with the drinking water at the facility, and feels it is maintained.

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

SUPERVISOR'S NAME: Michael Cava	TELEPHONE: (323) 400-7397
LICENSING EVALUATOR NAME: Jade Jordan	TELEPHONE: (650) 388-2300
LICENSING EVALUATOR SIGNATURE:	DATE: 08/12/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/12/2020

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 11-AS-20200610151452

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: 08/12/2020

NARRATIVE

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LPA interviewed other residents in the facility, and the consensus is that there is no issue or spoiled taste, from drinking water provided by the facility.

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

An exit interview was conducted and a copy of this report was given to Administrator

SUPERVISOR'S NAME: Michael Cava	TELEPHONE: (323) 400-7397
LICENSING EVALUATOR NAME: Jade Jordan	TELEPHONE: (650) 388-2300
LICENSING EVALUATOR SIGNATURE:	DATE: 06/25/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/25/2020

LIC9099 (FAS) - (06/04)

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