197608029-5-19-2023-11-AS-MVAO-CTMMQY-20230711094927

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608029
Report Date: 02/08/2023
Date Signed: 05/19/2023 05:28:37 PM

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
09/14/2022 and conducted by Evaluator Pamela Bunker

COMPLAINT CONTROL NUMBER: 11-AS-20220914141831

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: 226	DATE:	02/08/2023
		UNANNOUNCED	TIME BEGAN:	08:30 AM
MET WITH:	Janie Acosta		TIME COMPLETED:	02:45 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff did not properly assess residents needs for care
Staff did not prevent residents from pushing each other
Staff are not providing a comfortable environment for resident

INVESTIGATION FINDINGS:

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

Licensing Program Analyst (LPA) Pamela Bunker conducted an unannounced complaint visit on Wednesday, February 08, 2023. Upon arrival at the facility. LPA Bunker called the facility via telephone and conducted a Risk Assessment. Based on the assessment, the facility is cleared of COVID-19 infection. LPA Bunker met with Executive Director Janie Acosta. LPA Bunker explained the purpose of today's visit.

The investigation consisted of the following: During the course of the investigation on 09/20/2022 and 02/08/2023, LPA Bunker interviewed staff 1-4 (S1-S4) and residents 1-23 (R1-R23). LPA Bunker asked questions relevant to the nature of the complaint. S1-S4 and R1-R23 all stated staff properly assess residents' needs for care, staff prevents residents from pushing each other, and staff is providing a comfortable environment for residents.

See continued LIC9099-C page 2

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Stephanie Cifuentes	TELEPHONE: (661) 644-7743
LICENSING EVALUATOR NAME: Pamela Bunker	TELEPHONE: (323) 213-1113
LICENSING EVALUATOR SIGNATURE:	DATE: 02/08/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/08/2023

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 2

Control Number 11-AS-20220914141831

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: 02/08/2023

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

Continued LIC9099-C page 2

Allegation #1: Staff did not properly assess resident's needs for care
Staff 1-4 (S1-S4) and residents 2-23 (R2-R23) stated all residents are properly assessed upon admission and resident's care and supervision needs are being met. Resident 1 (R1) stated he is in the memory care unit and that he is independent. R1 stated the people in memory care have more problems than he has and he doesn't belong there. R1 stated the residents in memory care have physical and mental problems. R1 stated he is not in the same category. R1 stated he has bad memory; he is forgetful and can't remember things. S1-S4 and R2-R23 stated staff properly assess residents before admission. S1-S4 and R2-R23 denied the allegation.
Allegation #2: Staff did not prevent residents from pushing each other.
S1-S4 and R1-R23 stated staff does prevent residents from pushing each other. If staff witness any pushing or punching, they will intervene and make the residents stop immediately. S1-S4 and R1-R23 stated physical abuse is not allowed at the facility. S1-S4 and R1-R23 denied the allegation.
Allegation #3: Staff are not providing a comfortable environment for resident
S1-S4 and R1-R23 stated they are provided with a comfortable living environment. R1-R23 stated they were happy and comfortable living at the facility. S1-S4 and R2-R23 denied the allegation.

Investigation revealed the following: Staff 1-4 (S1-S4) and residents 2-23 (R2-R23) interviewed stated the above allegations are false. Staff 1-4 (S1-S4) stated resident 1 (R1) was properly assessed. S1-S4 stated R1 is high functioning and not able to take care of himself. S1-S4 stated R1 is supposed to be in the memory care unit according to his doctor’s orders and recommendation, he is not an assisted living resident. S1-S4 and R1-R23 stated punching another resident is prohibited and not allowed. The facility has zero tolerance, and staff will intervene to prevent an incident like this from occurring. S1-S4 stated that staff are mandated reporters and must report all incidents to Community Care Licensing and the appropriate agencies. S1-S4 and R1-R23 stated residents residing in the facility communicate with other residents. S1-S4 and R1-R23 stated residents go outside and they are around other residents. R2-R23 stated they are happy and like living here. S1-S4 and R2-R23 stated the allegations are false.
Based on interviews, available evidence, observation, information received, and records reviewed there was
not enough sufficient evidence to support the 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 deemed unsubstantiated.
There were no deficiencies cited. Exit interview conducted.

SUPERVISOR'S NAME: Stephanie Cifuentes	TELEPHONE: (661) 644-7743
LICENSING EVALUATOR NAME: Pamela Bunker	TELEPHONE: (323) 213-1113
LICENSING EVALUATOR SIGNATURE:	DATE: 02/08/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/08/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 2