197608029-5-19-2023-11-AS-JHAD-CS82EP-20230526172017

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608029
Report Date: 04/08/2023
Date Signed: 05/19/2023 02:15:29 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
03/27/2023 and conducted by Evaluator Ana Soto

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20230327134551

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:	08:40 AM
MET WITH:	Janie Acosta, executive Director		TIME COMPLETED:	09:15 AM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Facility did not provide responsible party with residents records as requested.

INVESTIGATION FINDINGS:

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

This amended report supersedes report dated 04/08/23. 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 Janie Acosta, Executive Director.

The investigation consisted of following: Interviews and Record reviews. LPA Soto conducted interview with the Executive Director. The LPA also requested copies of the following documents: On 04/06/23, LPA Soto conducted interviews with S#1 - Executive Director, S#2 - S#18, and R#1 - R#10. The LPA also requested copies of the following documents on 04/06/23: Copy of R#1 file - (Face Sheet, Dietary restrictions, Pre-Appraisals, Physician's Report, Hospital/ER visits, request from Attorney requesting file R#1(Dated 03/29/23), POA (dated 03/07/20,) copy of record release from facility for R#1 file(Dated – 3/31/23,) Copy of request for file from Witness #1 (Dated 03/24/23.)

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: 05/19/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/19/2023

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 2

Control Number 11-AS-20230327134551

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

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

Based on the LPA's investigation, the investigation revealed the following. For Allegation – Facility did not provide responsible party with resident’s records as requested. Interview conducted with S#1, communicated that they received the request on 03/27/23 for R1 records, via fax. She contacted the requestor on 03/27/23, after she received request and was coordinating with requestor via email and text to come and obtain file on 03/31/23. On 03/29/23, the Executive Director received PR Attorney request for R#1 entire file via fax. Facility provided copy of R#1 file on 03/31/23. Attorney’s representative went to facility to obtain and received copy of R#1’s entire file. Interviews conducted with S#2 – S#18, staff communicated they have no knowledge of facility not providing records to Responsible Parties of residents. Interviews conducted with R#1 – R#10, 10 of 10 residents interviewed communicated that they have never had the need to request to see their file. LPA reviewed the attorney’s file request dated 03/29/23, requesting entire file for R#1. LPA also reviewed the copy of records release letter dated (03/31/23.) The facility provided R#1’s file within the allotted time under Title 22 regulations, which states, the facility has two Business days to provide resident or responsible party the requested resident file. The interviews and records reviewed do not concur with the above allegation.

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

An exit interview was conducted with Janie Acosta, Executive 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: 05/19/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/19/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 2