197608029-11-3-2022-11-AS-MVAO-CN7TX3-20230118140627

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608029
Report Date: 11/03/2022
Date Signed: 11/03/2022 11:13:56 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO, 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
03/01/2021 and conducted by Evaluator Martessa Brown

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20210301103601

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: 225	DATE:	11/03/2022
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Reggie Jones Administrator		TIME COMPLETED:	11:15 AM

ALLEGATION(S):

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Unqualified staff administered medications to residents.
Facility had scabies outbreak.
Facility had rignworm outbreak.
Facility has roaches.
Facility has bed Bugs.
Food is not of the quality necessary to meet the needs of the residents.
Facility is not clean.

INVESTIGATION FINDINGS:

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On 11/3/22, Licensing Program Analysts (LPA) Martessa Brown conducted a subsequent visit unannounced complaint visit in order to render investigation findings. LPA Brown called and spoke to front desk and conducted a risk assessment before entering and there are no Covid-19 cases. LPA was greeted by Reggie Jones and explained the purpose of today's visit regarding the above allegations.

The investigation consisted of the following: LPA conducted interviews with the Administrator, (8) staff and (9) clients. A review of the current staff and resident roster, staff service records, incident reports and other pertinent records was reviewed. A tour of the physical plant was conducted on 3/9/2021 and 8/4/22.

Investigation revealed the following:

Allegation: Unqualified staff administered medications to residents.
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Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Martessa Brown	TELEPHONE: (714) 743-4597
LICENSING EVALUATOR SIGNATURE:	DATE: 11/03/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/03/2022

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

LIC9099 (FAS) - (06/04)

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Control Number 11-AS-20210301103601

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: 11/03/2022

NARRATIVE

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Complaint details stated caregivers apply antibiotic ointments to residents. On 3/9/21, LPA conducted interview with former administrator Brad DeHann and he stated only medical technician are able to administer medication. On 8/4/22, LPA conducted interviews resident #1-9 regarding the above allegation. Residents stated they have not received medications/ointments through caregivers. Residents stated only medical technician give them their medication and doesn’t have any concern. On 8/4/22, LPA conducted interviews with administrator and staff members #1-8 regarding the above allegation. Administrator and staff stated medications are prepared by medical technician and staff nurse per shift and complete mars book. LPA reviewed medication training records. Based on interviews conducted and documentation the above allegation is unsubstantiated.

Allegation: Facility had scabies outbreak.
Complaint details allegation stated facility has scabies. On 3/9/21, LPA conducted interview with former Administrator Brad DeHann and he stated 5 residents in memory care unit had scabies. LPA verified scabies protocol and notified right away residents, Doctors, DPH, CCLD and completed incident reports. On 8/4/22, LPA conducted interviews resident #1-9 regarding the above allegation. Residents stated they were not aware of a scabies outbreak in the facility. On 8/4/22, Interviews were conducted with Administrator Jones and staff members, 4 out of 8 staff confirmed scabies outbreak in memory care on June 2022. Staff and administrator stated they follow scabies protocol the and Department of Public Health was notified. LPA contacted the Health Department and confirmed scabies outbreak was reported on 6/10/22 , 1 confirmed case and 4 suspected and was cleared on 6/21/22. LPA reviewed incident reported on 6/9/22 regarding 1 confirm case and possible contacts. LPA reviewed facility's Scabies protocol procedures and doctor’s orders. Documents and interviews confirm that facility followed scabies protocol. Based on interviews conducted and documentation. The above allegation is unsubstantiated.

continuation next page.

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Martessa Brown	TELEPHONE: (714) 743-4597
LICENSING EVALUATOR SIGNATURE:	DATE: 11/03/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/03/2022

LIC9099 (FAS) - (06/04)

Page: 2 of 4

Control Number 11-AS-20210301103601

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: 11/03/2022

NARRATIVE

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Allegation: Facility had ringworm outbreak.

On 3/9/21, LPA conducted interview with former Administrator Brad DeHann and he stated doctor had contacted them and validated there was no residents with ringworms. 8/4/22, LPA conducted interviews resident #1-9 regarding the above allegation. Residents stated they were not aware of a of any ringworm outbreak in the facility. On 8/9/22, LPA conducted interviews with Administrator and staff members #1-8 regarding the above allegation. They stated there was no ringworm outbreak and had no concerns. LPA also contact the Health Department and reviewed documents and there was no report to indicate a ringworm infestation. Based on interviews conducted and documentation. The above allegation there was no evidence of ringworms in the facility therefore the allegation is unsubstantiated.

Allegations: Facility has roaches and bed bugs
complaint details stated the facility has roaches and bedbugs due to the facility not being clean. On 3/9/21, LPA conducted interview with former Administrator Brad DeHann and he stated one resident had a concern. Regarding bed bugs he stated none during that time. Pest control comes out regularly. On 8/4/22, LPA conducted interviews resident #1-9 regarding the above allegation. Residents stated they had no bed bugs or roaches in their room. LPA conducted interviews with administrator and staff members #1-8 regarding the above allegations they stated there was no roaches, 3 staff stated there was one room with bed bugs and they promptly called pest control and took care of the problem . They also stated pest control comes twice a month. LPA reviewed Orkin’s pest control records and from invoice on January 2021 to present and receipts indicated preventive measure were taken for spot check for insects. LPA observed the facility bedrooms and common area and did not see any signs of roaches or bedbugs. based on interviews and documents facility has pest control coming out twice a month for preventive measure. Based on interviews conducted and documentation. The above allegation is unsubstantiated.

Continuation next page.

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Martessa Brown	TELEPHONE: (714) 743-4597
LICENSING EVALUATOR SIGNATURE:	DATE: 11/03/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/03/2022

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 11-AS-20210301103601

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: 11/03/2022

NARRATIVE

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Allegation: Food is not of the quality necessary to meet the needs of the residents.

Complaint details stated food is not cooked. On 3/9/21, LPA conducted interview with former administrator Brad DeHann and he stated cooks are qualified and trained and facility has dieticians. On 8/4/22, LPA conducted interviews resident #1-9 regarding the above allegation. Residents stated they had no problems with receiving under cook food or being cold. Residents also have not heard any complaints from other residents LPA conducted interviews with administrator and staff members #1-8 regarding the above allegations they stated food is serve 3 times a day and had no concern with the food quality. LPA reviewed staff training food handler certificates, menus and detain logs. LPA toured the facility kitchen. Based interviews conducted and documentation. The above allegation is unsubstantiated.

Allegation: Facility is not clean.

Complaint details stated has mold on walls and carpet smells. On 3/9/21, LPA conducted interview with former Administrator Brad DeHann and he stated facility is clean daily, bedrooms are vacuumed, and deep clearing is done weekly. On 8/4/22, LPA conducted interviews resident #1-9 regarding the above allegation. Residents stated they had no problems with facility not being clean. They stated housekeeping cleans their bedrooms every day, bathrooms and take out the trash. They stated had no concerns. LPA conducted interviews with administrator and staff members #1-8 They stated housekeeping cleans every day and also deep cleans. LPA reviewed housekeeping Deeping cleaning schedule for all floors. LPA toured the facility bedrooms, common areas and all 3 floors, and the facility was clean. Based on interviews conducted and documentation. The above allegation is unsubstantiated.

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.

An exit interview was conducted with Administrator Reggie Jones, and a sign hard copy was provided.

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Martessa Brown	TELEPHONE: (714) 743-4597
LICENSING EVALUATOR SIGNATURE:	DATE: 11/03/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/03/2022

LIC9099 (FAS) - (06/04)

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