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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197608029
Report Date: 02/23/2022
Date Signed: 03/30/2022 02:49:11 PM

Unsubstantiated


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
01/11/2022 and conducted by Evaluator Jose Calderon
COMPLAINT CONTROL NUMBER: 11-AS-20220111140048
FACILITY NAME:VISTA DEL MAR SENIOR LIVINGFACILITY NUMBER:
197608029
ADMINISTRATOR:JAMES BENDERFACILITY TYPE:
740
ADDRESS:3360 MAGNOLIA AVENUETELEPHONE:
(562) 595-1559
CITY:LONG BEACHSTATE: CAZIP CODE:
90806
CAPACITY:300CENSUS: 186DATE:
02/23/2022
UNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:ADMINISTRATOR REGGIE JONESTIME COMPLETED:
02:58 PM
ALLEGATION(S):
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Facility is not following COVID protocol
INVESTIGATION FINDINGS:
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On 02/23/2022 around 1pm Licensing Program Analyst (LPA) Jose Calderon initiated a complaint investigation to deliver the investigation findings for the allegation listed above, today’s complaint investigation was conducted face to face with Administrator Reggie Jones.

The Investigation consisted of the following: On 02/23/2022 LPA Calderon interviewed witness 1 for complaint. On 01/12/2022 LPA Calderon interviewed Administrator S1 and conducted a tour of the physical plant. On 02/23/2022 LPA Calderon obtained copies of Staff and Resident rosters, deep cleaning records and disinfection records for the facility. On 01/12/2022 LPA Calderon interviewed S2-S4. On 02/23/2022 LPA Calderon interviewed R1-R10 for complaint.

The investigation revealed the following:
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Janae HammondTELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Jose CalderonTELEPHONE: (323) 213-1153
LICENSING EVALUATOR SIGNATURE:

DATE: 02/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/23/2022
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 2
Control Number 11-AS-20220111140048
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: 02/23/2022
NARRATIVE
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Allegation: Facility is not following COVID protocol. It is alleged that the Facility is not following COVID protocol. On 01/12/2022 LPA Calderon interviewed S1-S4 who stated that staff does clean and disinfect all common areas and that all residents and staff wear mask and follow DPH and DSS guide lines regarding Covid-19. On 02/23/2022 LPA Calderon interviewed R1-10 who all state that the facility is cleaned daily, and all staff and residents must wear masks while inside the facility. On 02/23/2022 LPA Calderon interviewed W1 who states that the facility does not supply clean masks to staff but can state that the facility is cleaned daily. W1 also suggest that the facility does not pay for overtime due to Covid-19. On 02/23/2022 LPA Calderon reviewed the cleaning documents and the facility common areas and rooms are done daily.

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.



A telephonic exit interview was conducted with Administrator Reggie Jones, and a hard copy was provided by hand for the facility records




SUPERVISOR'S NAME: Janae HammondTELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Jose CalderonTELEPHONE: (323) 213-1153
LICENSING EVALUATOR SIGNATURE:

DATE: 02/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/23/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2