197608029-6-21-2022-11-AS-JHAD-CFSP96-20220627110637

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608029
Report Date: 02/23/2022
Date Signed: 06/21/2022 09:57:44 AM

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
02/14/2022 and conducted by Evaluator Jose Calderon

COMPLAINT CONTROL NUMBER: 11-AS-20220214121625

FACILITY NAME:	VISTA DEL MAR SENIOR LIVING		FACILITY NUMBER:	197608029
ADMINISTRATOR:	JAMES BENDER		FACILITY TYPE:	740
ADDRESS:	3360 MAGNOLIA AVENUE		TELEPHONE:	(562) 595-1559
CITY:	LONG BEACH	STATE: CA	ZIP CODE:	90806
CAPACITY:	300	CENSUS:	DATE:	02/23/2022
		UNANNOUNCED	TIME BEGAN:	09:15 AM
MET WITH:	ADMINISTRATOR REGGIE JONES		TIME COMPLETED:	01:00 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Facility is not allowing resident to have visitors.
Resident is being neglected while in care.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

On 02/23/2022 around 9am 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 02/15/2022 LPA Calderon interviewed witness 3 for complaint. On 02/23/2022 LPA Calderon interviewed Administrator S1 and conducted a tour of the physical plant. LPA Calderon obtained copies of Staff and Resident rosters, Resident #1’s record (Needs and Service Plan, Pre-Placement Appraisal, MARS (3 months), Physicians Report. On 02/23/2022 LPA Calderon interviewed S2-S6. On 02/23/2022 LPA Calderon interviewed witness 1 – 2. On 02/23/2022 LPA Calderon interviewed R1 for complaint. On 02/23/2022 LPA Calderon reviewed Needs and Services Plan, Physician Report, prior admission report from prior facility, hospital records, power of attorney and email from POA and facility all for R1. On 05/02/2022 LPA Calderon interviewed R2 - R9 for complaint.

The investigation revealed the following:

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Jose Calderon	TELEPHONE: (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-20220214121625

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

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

Allegation: Facility is not allowing resident to have visitors. It is alleged that the Facility is not allowing resident to have visitors. On 02/15/2022 LPA Calderon interviewed W3 who stated that the POA would not allow W3 to visit the resident and that the facility refused for W3 to enter the facility and visit R1. On 02/23/2022 LPA Calderon interviewed S1 who stated that POA who is the W1 would not allow W3 to visit R1. W1 – W2 state that they will not allow W3 to visit R1 since R1 gets agitated when R1 speaks to W3 and it is not good for his health. On 02/23/2022 LPA Calderon interviewed R1 who states R1 is very happy with the care given by the facility and that R1 understood what R1 was signing at the hospital and that R1 does not want to see W3. On 05/02/2022 LPA Calderon interviewed R2 – R9 who state that they have no issues with family members visiting when they want to.

Allegation: Resident is being neglected while in care. It is alleged that Resident is being neglected while in care. On 02/15/2022 LPA Calderon interviewed W3 who stated that she does not have any issues with the current facility care but does have issues with the prior facility care for R1. On 02/23/2022 LPA Calderon interviewed S1 who stated that S1 has not received any feedback from W1-W3 regarding the care of R1 and that no staff have told S1 of any issues with care. On 02/23/2022 LPA Calderon interviewed W1-W2 who stated that facility is giving great care to R1. On 02/23/2022 LPA Calderon interviewed S2-S6 all state that R1 is given the best care possible, even if R1 refuses care from staff. On 02/23/2022 LPA Calderon interviewed R1 who state that he loves living at the facility and has no issues with the care given to R1. On 05/02/2022 LPA Calderon interviewed R2 – R9 all state that the facility provides the best care possible and no staff neglects any resident.

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 Hammond	TELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Jose Calderon	TELEPHONE: (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