197608029-7-6-2023-11-AS-MVAO-CUYU96-20230823152237

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608029
Report Date: 07/06/2023
Date Signed: 07/06/2023 05:33:43 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 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
11/23/2022 and conducted by Evaluator Jeremiah Randle

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20221123145630

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: 237	DATE:	07/06/2023
		UNANNOUNCED	TIME BEGAN:	09:54 AM
MET WITH:	Janie Acosta Executive Director		TIME COMPLETED:	05:30 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Facility staff did not take residents to scheduled medical appointments.

INVESTIGATION FINDINGS:

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

The Investigation Consisted Of The Following

On 7/06/2023, Licensing Program Analyst (LPA) Jeremiah Randle, conducted a complaint investigation visit to deliver complaint findings to the above-named facility for the allegation listed above. LPA was met by Janie Acosta Executive Director (S1). The LPA explained to (S1) the purpose of the visit. The investigation consisted of the following: LPA conducted interviews with (3) staff members, and interviewed (5) residents, resident R1 is deceased as of 12/17/22. The LPA also reviewed the following documents provided by Janie Acosta Executive Director (S1): Staff roster, Client roster, transportation schedule, Residence and Care Agreement, Incident Report from 12/22/22, Needs and Services Plan, and Physician Report for Resident R1.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Jeremiah Randle	TELEPHONE: 323-213-1116
LICENSING EVALUATOR SIGNATURE:	DATE: 07/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/06/2023

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-20221123145630

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: VISTA DEL MAR SENIOR LIVING	FACILITY NUMBER: 197608029
	VISIT DATE: 07/06/2023

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

The Investigation Revealed The Following.

Allegation: Facility staff did not take residents to scheduled medical appointments. PA interviewed three (3) staff members all denied the allegation. LPA reviewed facility documents that provide facility clients with transportation to doctor appointments, and back home to the facility. R1 was not entered as a resident that received transportation services from the facility. S1 informed the LPA, that the facility arranges client medical appointments, and provides clients transportation to and from the medical location if requested from the resident R1 had not requested services as R1 was independent. S1 also stated resident would have received transportation services even on short if required, however R1 never requested service R1 was independent. S1 stated that the facility has a facility van to transport clients to activities, and medical appointments. In addition, the facility staff will transport clients to other locations when necessary. Residential Care staff 3 of the 3 staff members interviewed, informed the LPA, that they transport clients to and from medical appointments when requested and R1 never requested services for transportation to medical appointments as R1 was independent and always used public transportation for various activities. In addition, 3 of 3 staff member, informed the LPA that R1 makes all self-medical appointments, also R1 has never been denied medical transportation services. LPA reviewed R1’s needs and services plan which indicates R1 was not designated as having a need for transportation services to medical appointments. LPA interviewed (5) residents all residents denied the allegation, Facility staff did not take residents to scheduled medical appointments, further residents stated the facility has not been the cause of missed medical appointments per residents’ statements.

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Jeremiah Randle	TELEPHONE: 323-213-1116
LICENSING EVALUATOR SIGNATURE:	DATE: 07/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/06/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 11-AS-20221123145630

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: VISTA DEL MAR SENIOR LIVING	FACILITY NUMBER: 197608029
	VISIT DATE: 07/06/2023

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

Findings

Based on information gathered, the LPA did not find sufficient evidence to support allegation Facility staff did not take residents to scheduled medical appointments.

Although the allegation 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 allegation is Unsubstantiated.

An exit interview was conducted and a copy of the LIC 9099 was provided to Janie Acosta Executive Director Executive Director

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Jeremiah Randle	TELEPHONE: 323-213-1116
LICENSING EVALUATOR SIGNATURE:	DATE: 07/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/06/2023

LIC9099 (FAS) - (06/04)

Page: 3 of 3