197608029-9-1-2023-11-AS-MVAO-CWXSEF-20231025134840

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608029
Report Date: 08/31/2023
Date Signed: 09/01/2023 09:22:19 AM

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
07/31/2023 and conducted by Evaluator Lizeth Villegas

COMPLAINT CONTROL NUMBER: 11-AS-20230731132017

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:	08/31/2023
		UNANNOUNCED	TIME BEGAN:	08:45 AM
MET WITH:	Executive Director Janie Acosta		TIME COMPLETED:	09:53 AM

ALLEGATION(S):

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Staff are not ensuring a safe and healthful environment by turning a resident timely.
Facility is malodorous.

INVESTIGATION FINDINGS:

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On 08/31/23 at 8:45am, Licensing Program Analyst (LPA) Lizeth Villegas conducted a subsequent complaint visit to render investigation finding. LPA met with Executive Director Janie Acosta and the purpose of today’s visit was explained.

The investigation consisted of the following: On 08/09/23 LPA interviewed Executive Director Janie Acosta (ED), staff #1-9 (S1-S9) and interviewed residents # 1-10 (R1-R10). LPA obtained copies of the following for R1's; complete file, Service plan, turning log (8/1/23-8/9/23), staff and resident rosters, cleaning logs, laundry schedule, copy of Group 7 log, a copy of in-service staff training for repositioning residents (6/2/23), copy of end of life-hospice in-service training (2/17/23).

The investigation revealed the following:
Allegation- Staff are not ensuring a safe and healthful environment by turning a resident timely.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Lizeth Villegas	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 08/31/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/31/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 11-AS-20230731132017

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: 08/31/2023

NARRATIVE

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It is alleged the staff was to turn R1 at 2PM and at 4PM and the sign in sheet had not been signed off. On 08/09/23 LPA interviewed Executive Director Janie Acosta (ED), regarding the above allegation, ED denied the allegation above. Per ED, LVN’s and Caregivers are all trained in repositioning residents and residents are being turned every two hours. ED informed LPA that she does not recall how often R1 was to be repositioned. On 08/09/23 LPA interviewed R1-R10 regarding the above allegations, 10 out of 10 residents interviewed denied the allegation. On 08/09/23, LPA interviewed S1—S9, 9 out of 9 staff interviewed denied the above allegation. 6 of 9 staff interviewed reported that residents they are assigned to for the day are being turned every 2 hours. LPA conducted a review of R1 service plan dated 07/31/23 which indicates R1 is to be repositioned every 2 hours. LPA observed a repositioning log dated 08/01/23-08/09/23 and did not observe any missing signatures. LPA observed documented staff training records in repositioning residents on 06/02/2023 and hospice care dated 02/17/2023.

Allegation: Facility is malodorous.

It is alleged the first-floor hallway that is close to the dining room had a strong stench of feces because the staff have not cleaned the area. On 8/9/23, LPA interviewed the Executive Director regarding the allegation. According to the ED, the facility is cleaned daily by housekeeping and indicated there is a housekeeping schedule. The ED denied the allegation. On 8/9/23, LPA interviewed Staff #1-9 and 9 of the 9 staff interviewed denied the allegation. LPA interviewed Residents #1-10 and 10 of 10 residents interviewed denied the allegation. On 8/9/23, LPA conducted a tour of the facility physical plant and did not find the facility malodorous, and LPA did not observe any areas that required cleaning at the time of visit. LPA conducted a file review and observed the cleaning schedule and documented training for housekeeping staff.

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.

Exit interview conducted with Executive Director Janie Acosta and a copy of this report was provided.

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Lizeth Villegas	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 08/31/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/31/2023

LIC9099 (FAS) - (06/04)

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