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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197608029
Report Date: 11/17/2023
Date Signed: 11/20/2023 08:46:44 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
11/14/2023 and conducted by Evaluator Lizeth Villegas
COMPLAINT CONTROL NUMBER: 11-AS-20231114134358
FACILITY NAME:VISTA DEL MAR SENIOR LIVINGFACILITY NUMBER:
197608029
ADMINISTRATOR:JANIE ACOSTAFACILITY TYPE:
740
ADDRESS:3360 MAGNOLIA AVENUETELEPHONE:
(562) 595-1559
CITY:LONG BEACHSTATE: CAZIP CODE:
90806
CAPACITY:300CENSUS: 246DATE:
11/17/2023
UNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Resident care director Sidona CordisTIME COMPLETED:
03:00 PM
ALLEGATION(S):
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Staff are not properly addressing scabies at facility.
INVESTIGATION FINDINGS:
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On 11/17/23 at 9 am Licensing program analyst (LPA) Lizeth Villegas conducted an initial vist rageding the allegation above. 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 the following: Staff and client rosters, and the facilities Prevention and contol of scabies in California healthcare settings.

On 11/17/23 LPA interviewed Resident Care Director(D1), Staff # 1- 11(S1-S11), residents # 1- 10(R1-R10), and conducted a records review of to confirm facility has a scabies prevention and control plan.

The investigation revealed the following: Allegation: Staff are not properly addressing scabies at facility.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Janae HammondTELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Lizeth VillegasTELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:

DATE: 11/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/17/2023
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-20231114134358
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: 11/17/2023
NARRATIVE
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It is being alleged that staff are not properly addressing scabies at facility. On 11/17/23 LPA Villegas interviewed D1, who denied the allegation above. Per D1, there were 2 residents a few weeks ago but treatment has been completed and the public health department was notified. On 11/17/23 LPA Villegas interviewed R1-R10 regarding the allegation above, 10 of 10 residents interviewed denied the allegation above. On 11/17/23 LPA Villegas interviewed S1-S11 regarding the allegation above, 10 of the 11 staff interviewed denied the allegation above, 1 of the 11 staff interviewed corroborated the allegation and indicated that the facility failed to properly address scabies case. On 11/14/23 LPA reached out to Long Beach Department of Public Health and confirmed facility reported scabies and followed the recommended treatment plan.

Although the allegation may have happened or is valid there is no preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is deemed unsubstantiated.

Exit interview conducted with Resident Care Director Sidonia Cordis, and a copy of this report was provided.

SUPERVISOR'S NAME: Janae HammondTELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Lizeth VillegasTELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:

DATE: 11/17/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/17/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2