197608029-10-12-2023-11-AS-JHAD-CY7VZL-20231204155254

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608029
Report Date: 10/11/2023
Date Signed: 10/12/2023 08:30:14 AM

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
10/02/2023 and conducted by Evaluator Lizeth Villegas

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20231002152933

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: 240	DATE:	10/11/2023
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Resident Care Director Sidonia Cordis		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

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Facility staff failed to properly address pests control problem.
Staff serve food of poor quality.
Facility staff did not ensure eating utensils and dishes are sanitary and in good repair.

INVESTIGATION FINDINGS:

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On 10/11/23 at 9 am Licensing program analyst (LPA) Lizeth Villegas conducted an initial complaint investigation visit regarding the above allegation(s). LPA met with Resident Care Director Sidonia Cordis (D1) as the purpose of today’s visit was explained.

During today's visit LPA obtained copies of staff and resident rosters, Pest control invoices, menus for September and October, Dietician records, Food handlers’ certificates, In service for food handling, in services for sanitation and housekeeping schedule. LPA toured the kitchen, dining room area, and 5 resident bedrooms. On 10/11/23 LPA interviewed Resident Care Director(D1), Staff # 1-9 (S1-S9), residents # 1-1 (R1-R10) and witness #1 (w1) via phone interview. LPA was later joined by Director Janie Acosta.
The investigation revealed the following: Allegation: Facility staff failed to properly address pests control problem.
On 10/11/23 LPA interviewed S6 regarding the above allegation, per S6 facility has a contract with Terminix commercial who comes out 2 times a month to spray dining room, kitchen area, memory care

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Lizeth Villegas	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 10/11/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/11/2023

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-20231002152933

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: 10/11/2023

NARRATIVE

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kitchen, common areas, all offices, 10 bedrooms per visit and a flush is done quarterly in areas where food is prepped. LPA interviewed R1-R10, 5 out of 10 residents interviewed denied the allegation above, 5 out of 10 residents interviewed reported seeing roaches in their restroom. LPA interviewed S1-S10 who denied the allegation above. 10 out of 10 staff reported the facility and bedrooms are cleaned daily and bedrooms are deep cleaned once a week. On 10/11/23 LPA interviewed W1 via phone who confirmed facility is on the recommended treatment plan from Terminix pest control. LPA reviewed Terminix invoices and confirmed Terminix visits the facility 2 times a month.

Allegation: Staff serve food of poor quality.

On 10/11/23 LPA interviewed S2 regarding the above allegation, S2 reports that the facility has many vendors who are known for top quality food and the facility provides alternative meal options and accommodates special diets. S2 stated food supplies are checked for expiration dates and freshness upon delivery. S2 reported that food menu is reviewed by dietician once a month, kitchen is aware of modified diets, meetings are conducted sometimes once a month with residents and that there is a food board in the kitchen that helps kitchen staff identify what meal is for each resident. LPA interviewed R1-R10, 10 out of 10 residents interviewed denied the allegation above. LPA interviewed S1-S10 who denied the allegation above. LPA reviewed the facility menu and confirmed menu is checked monthly by dietician. While at the facility LPA observed food being served and did not observe any immediate concerns. LPA reviewed food handler certificates, menus and dietician records and did not observe any immediate concerns.

Allegation: Facility is utilizing dishes that are hazardous to residents.

On 10/11/23 LPA interviewed S2 regarding the above allegation, S2 reports that if any plate or utensils become broken, they are thrown out right away to ensure safety. Per S2 no resident has sustained injury due to plates or utensils. LPA interviewed S1 and S3-10 who denied the allegation above. LPA interviewed R1-R10, 9 out of 10 residents interviewed denied the allegation above, 1 out 10 residents reported that the serving plates are dirty. LPA toured the kitchen and dining room and did not observe any hazards utensils or immediate concerns.

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 Janie Acosta and a copy of this report was provided.

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Lizeth Villegas	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 10/11/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/11/2023

LIC9099 (FAS) - (06/04)

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