197608029-11-4-2022-11-AS-JCAN-CKUTE5-20221104143923

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 197608029
Report Date: 11/04/2022
Date Signed: 11/04/2022 02:39:56 PM

Document Has Been Signed on 11/04/2022 02:39 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME:	VISTA DEL MAR SENIOR LIVING		FACILITY NUMBER:	197608029
ADMINISTRATOR:	REGGIE JONES		FACILITY TYPE:	740
ADDRESS:	3360 MAGNOLIA AVENUE		TELEPHONE:	(562) 595-1559
CITY:	LONG BEACH	STATE: CA	ZIP CODE:	90806
CAPACITY:	300	CENSUS: 225	DATE:	11/04/2022
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	ADMINISTRATOR REGGIE JONES		TIME COMPLETED:	02:30 PM

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	On 11/04/2022 at 09:00 AM Licensing Program Analyst (LPA) Jose Calderon conducted an unannounced Annual required visit to Vista Del Mar Senior Living Facility (197608029) with a primary focus on infection control measures. LPA Jose Calderon was met by Administrator Reggie Jones and the purpose of today’s visit was explained. The facility is licensed to serve 300 elderly residents 59 years and older. There are currently 225 elder residents in care. There are 167 non-ambulatory and 75 ambulatory clients of which 38 residents are in the Memory Care Unit. The facility is a 2-story structure with 278 bedrooms and 4 common bathrooms, multimedia rooms, movie room, commercial kitchen, large dining room, large common patio, conference meeting room and staff offices. The facilities’ last fire drill was conducted on 10/24/2022 by Long Beach Fire Department.

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Jose Calderon	TELEPHONE: (323) 213-1153
LICENSING EVALUATOR SIGNATURE:	DATE: 11/04/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/04/2022

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: VISTA DEL MAR SENIOR LIVING	FACILITY NUMBER: 197608029
	VISIT DATE: 11/04/2022

NARRATIVE

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LPA Jose Calderon observed that all facility rooms are clean and in good repair. A comfortable temperature was observed, and the facility has central air and heating. LPA Jose Calderon observed the following during inspection of resident’s rooms: 105,106,113,206,207,212 mattresses are in good condition, adequate lighting present, plenty of dresser/closet space is present, and all bed linens present. All bedrooms contain furniture, lighting fixtures and personal storage space as required, all beds have the required amount of linen and mattress covers. LPA Jose Calderon observed fully stocked storage closet with bedding, towels, and toiletries supplies. Bathroom fixtures are clean, in good repair, and working properly and contain the required nonskid mats and grab bars. LPA Jose Calderon observed bathrooms were found to be within Title 22 regulation. Bathroom #1 hot water temperature properly measured at 108 degrees Fahrenheit, and bathroom #2 hot water temperature properly measured at 106 degrees Fahrenheit, and bathroom #3 hot water temperature properly measured at 109 degrees Fahrenheit, and bathroom #4 hot water temperature properly measured at 109 degrees Fahrenheit. The commercial kitchen hot water temperature properly measured at 121 degrees Fahrenheit. Facility (60) Carbon Monoxide and (60) Smoke Detectors hard wired and connected were tested and are working properly. The facility (12) Fire Extinguishers were checked and found to be fully charged and accessible. All exit doors in the facility have alarm systems. All toxins and knifes are locked/secured and inaccessible to residents. No weapons are stored in the premises. Commercial Kitchen was inspected and observed to be clean and operational. A 2-day supply perishable and 7-day supply of non-perishable foods are present in the facility. Emergency bottle water is in the kitchen storage room.

Medications are centrally stored and in a locked storage cabinet in the medication room. Facility first aid kits (12) is fully stocked with manual was checked and in order. Outside grounds were toured and no bodies of water were observed. All Exits/ Walkways around the home were free of debris and hazards. Outside patio furniture accessible to all residents. LPA Jose Calderon reviewed Ten (10) resident files were reviewed and found to be complete. LPA Jose Calderon reviewed Ten (10) resident medications and they were all found to be administered according to doctor's orders. LPA Jose Calderon reviewed Ten (10) staff files were checked and have the required documents. LPA Jose Calderon noted that the facility does not handle resident's money/cash resources. LPA Jose Calderon noted all the required documents are posted in the facility in a clearly visible area. LPA Jose Calderon noted the Administrator Reggie Jones Certification # 6048873740 expiration date of 07/22/2022 was NOT valid at time of visit. Administrator Reggie Jones provided written proof that his renewal with the state of California is in process.
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SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Jose Calderon	TELEPHONE: (323) 213-1153
LICENSING EVALUATOR SIGNATURE:	DATE: 11/04/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/04/2022

LIC809 (FAS) - (06/04)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: VISTA DEL MAR SENIOR LIVING	FACILITY NUMBER: 197608029
	VISIT DATE: 11/04/2022

NARRATIVE

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During the visit, LPA Jose Calderon observed the facility infection control practices. LPA Jose Calderon observed screening protocols for visitors, staff and residents, sanitizing stations (Located in common areas and restrooms). LPA Jose Calderon observed staff and residents were wearing face coverings, an isolation room and required postings throughout the facility. LPA Jose Calderon observed the facility has a 90-day supply of Personal Protective Equipment (PPE) located in a storage room.

LPA Jose Calderon advised the Administrator Reggie Jones to continuously monitor the Centers for Disease Control (CDC) website and Community Care Likening Provider Informational Notices (PIN) for any updates relating to COVID-19 guidance.

According to the California Code of Regulations (Title 22, Division 6, Chapter 8), LPA Jose Calderon did not observe any deficiencies therefore NO citations were issued at this time. An exit interview was conducted, and a copy of the Facility Evaluation Report was provided to Administrator Reggie Jones.

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Jose Calderon	TELEPHONE: (323) 213-1153
LICENSING EVALUATOR SIGNATURE:	DATE: 11/04/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/04/2022

LIC809 (FAS) - (06/04)

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