197608029-4-8-2023-11-AS-JHAD-CRVMGY-20230516093644

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608029
Report Date: 04/08/2023
Date Signed: 04/08/2023 09:39:01 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
02/13/2023 and conducted by Evaluator Ana Soto

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20230213121645

FACILITY NAME:	VISTA DEL MAR SENIOR LIVING		FACILITY NUMBER:	197608029
ADMINISTRATOR:	JANIE ACOSTA		FACILITY TYPE:	740
ADDRESS:	3360 MAGNOLIA AVENUE		TELEPHONE:	(562) 595-1559
CITY:	LONG BEACH	STATE: CA	ZIP CODE:	90806
CAPACITY:	300	CENSUS: 228	DATE:	04/08/2023
		UNANNOUNCED	TIME BEGAN:	09:15 AM
MET WITH:	Sidonia Cordis, Resident of Care services Director		TIME COMPLETED:	10:00 AM

ALLEGATION(S):

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Facility does not ensure residents are served food that is of good quality
Staff do not ensure residents special dietary needs are being met
Staff yell at residents
Staff do not speak to residents in an appropriate manner

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Ana Soto conducted a subsequent complaint investigation to deliver findings and decisions for the allegation listed above. Today’s complaint investigation was conducted with Sidonia Cordis, Resident of Care Services Director.

The investigation consisted of following: Interviews and Record reviews. On 02/22/23, LPA Soto conducted interview with the Executive Director. The LPA also requested copies of the following documents: Resident Roster, Staff Roster, File for R#1, R#2, & R#3 - (Dietary restrictions, Pre-Appraisals, Physician's Report, Admission Agreement, Needs and Service Plan.) Menu, and Sample of moving in notification. On 04/06/23, LPA Soto interviewed S#2 - S#18, and R#1 - R#10. LPA toured the dining area and kitchen. Observed residents having lunch in the dining room. Observed the special diet board for residents in the kitchen. LPA also took pictures of the food being prepared and served for lunch. LPA also requested copies of the following documents:

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Ana Soto	TELEPHONE: (323) 383-8284
LICENSING EVALUATOR SIGNATURE:	DATE: 04/08/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/08/2023

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 3

Control Number 11-AS-20230213121645

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: 04/08/2023

NARRATIVE

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Resident roster and Staff roster, Copy of Training for food server and Copy of Dietary Hall Meeting notes.

Based on the LPA's investigation, the investigation revealed the following. Allegation 1 – Facility does not ensure residents are served food that is of good quality. Interviews with S#1 – S#18, communicated they eat their lunch at the facility. The food is of good quality and good portions. They serve something different everyday and they have a variety of options in the menu. They also provide alternative items if they residents do not want what’s on the regular menu. They have a list of alternatives placed on the dining room tables and board right outside dining room, to make sure the resident knows what their options are. The food is cooked with low sodium, they do not prepare the food with too much salt, they provide residents with salt packages, when residents request it and can consume salt. Interviews conducted with R#2 -R#10, communicated the food is okay. They don’t put a lot of salt in the food, but they added if they need to. They also have a lot of alternatives and sometimes they don’t like what they serve, they just ask for the alternatives they have. The staff gets them what they want with no problem. LPA reviewed the main menu and the list of alternatives the facility offers healthy selections of food for the residents. LPA observed the food being prepared and served. The main dish was meat, vegetables, and a roll of bread. The residents were also having dessert pies (cherry and Apple.) The interviews, records and observations conducted do not concur with the above allegation.

Allegation 2 - Staff do not ensure residents special dietary needs are being met. Interviews with S#1 – S#18, communicated that the facility always abides by the residents’ special diet, if they have one. When the resident is admitted they are given what is called (Moving in Notification) which has the resident allergies, if any, and any special diets or restrictions the resident needs to have. The moving notification also has a picture of the resident and it’s posted on a board in the kitchen to assure the kitchen is giving the residents their proper meals. Interviews conducted with R#2 -R#10, communicated that they some have food restrictions and the facility always gives them the meals they can eat. They have never had a problem with the meals. They like the food being served at the facility. LPA observed the board with the resident’s (Moving in Notifications) with pictures, allergies, special diets and restrictions. The interviews, records and observations conducted do not concur with the above allegation.

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Ana Soto	TELEPHONE: (323) 383-8284
LICENSING EVALUATOR SIGNATURE:	DATE: 04/08/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/08/2023

LIC9099 (FAS) - (06/04)

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Control Number 11-AS-20230213121645

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: 04/08/2023

NARRATIVE

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Allegation 3 - Staff yell at residents. Interviews with S#1 – S#18, communicated, they have never yelled at any resident for any reason. Sometimes they speak in a loud voice to residents because some residents are hard of hearing. Interviews conducted with R#2 -R#10, communicated that they have never been yelled at by staff or anyone else. The staff is nice not mean. The interviews conducted do not concur with the above allegation.

Allegation 4 - Staff do not speak to residents in an appropriate manner. Interviews with S#1 – S#18, communicated that they have never disrespect's or spoke to any resident inappropriate manner. They would never allow anyone talk to another person in that manner, they would report it right away and put a stop to it. Interviews conducted with R#2 -R#10, communicated that they have never been spoken to inappropriate manner at by staff or anyone else. The staff is always nice. The interviews conducted do not concur with the above allegation.

Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are unsubstantiated

An exit interview was conducted with Sidonia Cordis, Resident of Care Services Director and a hard copy of report was provided.

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Ana Soto	TELEPHONE: (323) 383-8284
LICENSING EVALUATOR SIGNATURE:	DATE: 04/08/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/08/2023

LIC9099 (FAS) - (06/04)

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