197608029-2-1-2024-11-AS-JHAD-D32PUU-20240304103805

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608029
Report Date: 02/01/2024
Date Signed: 02/01/2024 01:54:03 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, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/22/2024 and conducted by Evaluator Lizeth Villegas

COMPLAINT CONTROL NUMBER: 11-AS-20240122170207

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: 242	DATE:	02/01/2024
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Resident care director Sidona Cordis		TIME COMPLETED:	02:45 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Facility staff fails to change resident's diaper.
Facility staff fails to re-position bedridden resident.
Facility staff fails to provide resident with basic services.

INVESTIGATION FINDINGS:

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

On 02/01/24 at 09:00am, Licensing Program Analyst (LPA) Lizeth Villegas conducted an initial complaint visit regarding the allegation(s) above. LPA met with Resident care director (CD) Sidona Cordis as the purpose of today’s visit was explained.

The investigation consisted of the following: On 02/01/24 LPA interviewed CD, staff #1-9 (S1-S9), residents #1-10 (R1-R10), and obtained the following copies of the staff and resident roster, and a document listing residents that require toileting assistance and residents who are on hospice. LPA obtained the following for R1 and R2; Face sheet, Emergency I.D., admission agreement, physicians report, physicians order, needs and service plan, preplacement appraisal. A copy of R1's repositioning log was provided as well as a copy of the daily room service log.

The investigation revealed the following:
Allegation: Facility staff fails to change resident's diaper.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (424) 544-1027
LICENSING EVALUATOR NAME: Lizeth Villegas	TELEPHONE: (818) 391-9974
LICENSING EVALUATOR SIGNATURE:	DATE: 02/01/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/01/2024

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-20240122170207

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

FACILITY NAME: VISTA DEL MAR SENIOR LIVING	FACILITY NUMBER: 197608029
	VISIT DATE: 02/01/2024

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

It is being alleged facility staff fails to change resident's diaper. On 02/01/24 LPA interviewed CD regarding the above allegation, CD denied the allegation stating residents are checked on and changed every 2 hours. CD added a change can occur before the 2 hour mark if a resident has an accident. On 02/01/24 LPA interviewed S1-S9 regarding the above allegation, 9 of 9 staff interviewed denied the allegation above reporting that residents are changed every 2 hours or as needed depending on the residents needs. Per 9 of 9 staff there is a changing log for hospice residents. On 02/01/24 LPA interviewed R1-R10 regarding the above allegation, 7 of 10 residents interviewed denied the allegation above, 2 of the 10 residents interviewed reported they do not use diapers, and 1 of 10 residents interviewed did not provide an answer. On 02/01/24 LPA reviewed incontinent/changing log for R1 and did not observe any discrepancies.

Allegation- Facility staff fails to re-position bedridden resident.
It is being alleged that staff fails to re-position bedridden residents. On 02/01/24 LPA interviewed CD regarding the above allegation, CD denied the allegation stating bedridden residents are checked on and repositioned every 2 hours after they are changed. On 02/01/24 LPA interviewed S1-S9 regarding the above allegation, 9 of 9 staff interviewed denied the allegation above reporting that residents are repositioned every 2 hours and it is documented on a form located in the residents room. 9 of 9 staff continued to report that caregivers reposition residents and can obtain assistance from LVN when needed. On 02/01/24 LPA interviewed R1-R10 regarding the above allegation, 10 of 10 residents interviewed denied the allegation above reporting that staff are checking on resident often and their needs are being met. On 02/01/24 LPA reviewed repositioning log for R1 and did not observe any discrepancies.

Allegation: Facility staff fails to provide resident with basic services.
It is being alleged facility staff fails to provide resident with basic services when residents are asking for water. On 02/01/24 LPA interviewed CD regarding the above allegation, CD denied the allegation reporting that staff are constantly in residents room making sure residents have what they need. CD continued to report there is a list of bedridden residents which caregivers use to ensure residents have what they need. On 02/01/24 LPA interviewed S1-S9 regarding the above allegation, 9 of 9 staff interviewed denied the allegation above reporting that residents will use their pendants to request food/water and the caregivers will provide the items. On 02/01/24 LPA interviewed R1-R10 regarding the above allegation, 10 of 10 residents interviewed denied the allegation above reporting that staff are providing food/water when needed.

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 allegations are Unsubstantiated.

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

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (424) 544-1027
LICENSING EVALUATOR NAME: Lizeth Villegas	TELEPHONE: (818) 391-9974
LICENSING EVALUATOR SIGNATURE:	DATE: 02/01/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/01/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 2