197608029-9-16-2023-11-AS-MVAO-CW3PYA-20230927114337

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608029
Report Date: 09/16/2023
Date Signed: 09/16/2023 12:19:47 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
03/21/2023 and conducted by Evaluator Ernand Dabuet

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20230321145555

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: 239	DATE:	09/16/2023
		UNANNOUNCED	TIME BEGAN:	10:26 AM
MET WITH:	Andrea Perez		TIME COMPLETED:	11:37 AM

ALLEGATION(S):

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Resident was sexually abused while in facilities care.
Facility staff neglected resident resulting in unexplained bruising.

INVESTIGATION FINDINGS:

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On 9/16/23, Licensing Program Analyst (LPA) Ernand Dabuet conducted a subsequent complaint visit in order to render investigation findings. LPA met with (Andrea Perez, Marketing Director) and the purpose of the visit was explained.

The investigation consisted of the following: On 3/24/23, LPA Jeremiah Randle conducted the initial visit. LPA Randle conducted a tour of the physical plant and obtained copies of the following records: Resident Roster delineating care to bedridden residents, Staff Roster of staff who use the Hoyer lift, Physicians reports of bedridden residents, emergency contact information for each bedridden resident, East/West video camera footage of hallway between rooms 112 and 123. On 3/24/23, the complaint investigation was referred to the California Department of Social Services Investigations Bureau for investigation.

(Evaluation Report continues LIC 9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Ernand Dabuet	TELEPHONE: (323) 629-5526
LICENSING EVALUATOR SIGNATURE:	DATE: 09/16/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/16/2023

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-20230321145555

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: 09/16/2023

NARRATIVE

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The complaint was accepted for a full investigation and assigned to Special Investigator Douglas Real. As a part of the investigation Investigator Real obtain copies of Long Beach Police Department Police Report, Providence Little Company of Mary Hospital Records, True Carre Hospice Records and conducted interviews with Witness #1-3, Facility Administrator (A1), Staff #1-5 and Residents #1-3.

THE INVESTIGATION REVEALED THE FOLLOWING:

Allegation #1: Resident was sexually abused while in facilities care.

Allegation #2: Facility staff neglected resident resulting in unexplained bruising.

It is alleged R1 was sexually abused while in care due to unexplained bruising to R1 private areas. The complaint details alleged that a perpetrator may have enter R1 through the sliding glass door and assaulted R1. On 3/27/23 at 3:10pm, Investigator Real interviewed Janie Acosta (A1) regarding the allegation. A1 stated R1 has resided at the facility since 12/2022 and R1 health has continued to decline. A1 stated on 3/21/23 R1 Hospice Nurse came to the facility to bathe R1 and observe some bruising on R1. A1 stated all facility employees were unaware of R1 bruising and did not know how R1 sustained the bruising. A1 stated none of the staff have reported any incidents or falls involving R1. A1 indicated R1 is on blood thinners which could have contributed to the bruising. On 3/27/23, 5/10/23 and 6/19/23, Investigator Real interviewed Staff #1-5 (S1-S5), 5 out of 5 staff interview denied the allegation and stated they were unaware how R1 sustained bruising. 1 out of 5 staff interviewed stated staff observed the bruising on R1 at the same time R1 Hospice Nurse observed the bruising. The staff stated once staff observed the bruising staff checked R1 sliding glass door in room and observed it to be locked with a pen to prevent anyone outside the facility from opening it. On 5/10/23, Investigator Real interview Residents #1-3, 3 of the 3 residents interviewed denied the allegation. R1 was unable to recall any incidents nor expressed any concerns when R1 resided at Vista Del Mar Senior Living. Investigator interviewed Witness #1-3 regarding the allegations, 2 of the 3 witnesses interviewed were made aware of the bruising and expressed concerns of possible neglect at Vista Del Mar Senior Living. 1 of the 3 Witness denied finding any evidence to support the allegation of sexual abuse.

(Evaluation Report continues LIC 9099-C)

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Ernand Dabuet	TELEPHONE: (323) 629-5526
LICENSING EVALUATOR SIGNATURE:	DATE: 09/16/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/16/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 11-AS-20230321145555

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: 09/16/2023

NARRATIVE

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As a part of the investigation Investigator Real obtained and reviewed the Long Beach Police Department Police Report, Providence Little Company of Mary Hospital Records and True Care Hospice records. The review of the Long Beach Police Department revealed there is no evidence of a sexual assault and the investigation was concluded.

The review of Providence Little Company of Mary Hospital records date 3/21/23 revealed R1 was seen in the Little Company of Mary emergency department on 3/21/2023 for unexplained bruising. A physical exam was done and identified bruising on R1 lower extremities, buttocks, and trunk. R1 was also noted as having diagnosed with chronic anticoagulation and has been on long-term anticoagulants as well as aspirin. Multiple x-rays as well as a CT scan found no fractures. Records noted no obvious defensive wounds were identified. It was noted the bruising appears to be in the region of the victim's hips, groin, and back and it was speculated the bruising may be due to tight fitting clothing, use of a Hoyer lift, or possibly a fall. The victim was noted as not being in acute distress. The records indicated a forensic medical (SART exam - sexual assault response team) exam was conducted.

The review of True Care Hospice records revealed on 3/21/2023, a hospice nurse visited the R1 in the facility after a hospice aid found unexplained bruising. The hospice nurse observed traumatic bruising on the left arm, left hand, bilateral lower side abdomen, pubis area, right lateral mid abdomen, left under chest, right gluteal, posterior upper leg, right anterior upper leg, and right lateral lower leg. R1 was visited by a hospice nurse in the facility on 3/18/2023 and no bruises were observed at that time. R1 hospice medication list indicated R1 was receiving two anti-coagulants - 81 mg Aspirin once a day and 2.5 mg Eliquis twice a day.

A review of R1 prescribed medications was reviewed and revealed R1 has a prescription for Eliquis “is used to prevent serious blood clots from forming due to a certain irregular heartbeat or after hip/knee replacement surgery with side effects included easy bruising (WEBMD).

Based on interviews conducted, records reviewed and observations there is insufficient evidence to support the allegations. 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 Andrea Perez, and a copy of this report was provided.
This report serves as an amendment to clarify finding. on line #3. It does not supersedes the complaint investigation findings reflected on report created 09/16/23.

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Ernand Dabuet	TELEPHONE: (323) 629-5526
LICENSING EVALUATOR SIGNATURE:	DATE: 09/23/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/23/2023

LIC9099 (FAS) - (06/04)

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