197608029-3-1-2024-11-AS-JHAD-D35R9N-20240307114945

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608029
Report Date: 03/01/2024
Date Signed: 03/01/2024 01:47:11 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
11/23/2022 and conducted by Evaluator Lizeth Villegas

COMPLAINT CONTROL NUMBER: 11-AS-20221123130647

FACILITY NAME:	VISTA DEL MAR SENIOR LIVING		FACILITY NUMBER:	197608029
ADMINISTRATOR:	REGGIE JONES		FACILITY TYPE:	740
ADDRESS:	3360 MAGNOLIA AVENUE		TELEPHONE:	(562) 595-1559
CITY:	LONG BEACH	STATE: CA	ZIP CODE:	90806
CAPACITY:	300	CENSUS: 247	DATE:	03/01/2024
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Executive Director Janae Acosta		TIME COMPLETED:	02:15 PM

ALLEGATION(S):

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Facility staff are not dispensing medications as prescribed for resident.
Facility staff are not providing meals for resident.

INVESTIGATION FINDINGS:

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On 03/01/24 at 9:00 am, Licensing Program Analyst (LPA) Lizeth Villegas conducted an initial complaint visit regarding the allegations above. LPA met with Executive Director (ED) Janie Acosta as the purpose of today’s visit was explained.

The investigation consisted of the following: On 03/01/24 LPA obtained copies of staff and resident rosters, facility infection control plan, menu dated 10/30-12/03, a copy of assisted living isolation rooms, and the following documents for Resident #1 (R1); identification and emergency info. form, admission agreement, physicians report, needs and service paln, diet clarification request, and after visit summary. On 03/01/24 LPA interviewed Residents #1-09(R1-R09), Executive Director, staff #1- 7(S1-S7), and obtained copies of MAR for R10-R11.

The investigation revealed the following:
Allegation- Facility staff are not dispensing medications as prescribed for resident.

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: 03/01/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/01/2024

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-20221123130647

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: 03/01/2024

NARRATIVE

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It is being alleged that facility staff failed to dispense medication to residents while on quarantine for covid. On 03/01/24 LPA interviewed ED regarding the allegation above, ED denied the allegation above. Per ED, med techs administered medications in the room the residents were quarantined in while wearing full PPE. On 03/01/24 LPA interviewed S1-S7 regarding the allegation above, 7 of 7 staff interviewed denied the allegation above reporting med techs would administer medications in the quarantine room while wearing PPE. S1-S7 reported quarantine residents were checked on every two hours, however, residents were asked to use their call button when they needed any assistance. On 03/01/24 LPA interviewed R1-R9 regarding the allegation above, 8 of the 9 residents interviewed denied the allegation above stating medication was administered daily. 1 of the 9 residents interviewed reported never having covid. On 03/01/24 LPA conducted review of MAR for R10-R11 and did not observe any discrepancies.

Allegation: Facility staff are not providing meals for resident.
It is being alleged that the facility failed to provide residents with dinner while on quarantine for covid. On 03/01/24 LPA interviewed ED regarding the allegation above, ED denied the allegation above. Per ED, when a resident test positive for covid the resident is placed on the kitchens meal tray lists and kitchen staff will deliver the meal to residents door and caregivers will then provide the meal directly to the residents on quarantine. On 03/01/24 LPA interviewed S1-S7 regarding the allegation above, 7 of 7 staff interviewed denied the allegation above reporting that kitchen staff will bring residents tray to room door and the caregivers in full PPE will provide the tray directly to the residents. If a covid positive resident requires assistance with feeding, caregiver will assist in full PPE and discard PPE once feeding is completed. On 03/01/24 LPA interviewed R1-R9 regarding the allegation above, 8 of the 9 residents interviewed denied the allegation above stating 3 meals a day were provided in their quarentine bedrooms. 1 of the 9 residents interviewed reported never having covid or was placed in quarantine, however reports receiving 3 meals everyday. On 03/01/24 LPA reviewed facility menu and observed a variety of meals listed, LPA also observed lunch pass and observed residents being accommodated with different food options upon request.

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: (424) 544-1027
LICENSING EVALUATOR NAME: Lizeth Villegas	TELEPHONE: (818) 391-9974
LICENSING EVALUATOR SIGNATURE:	DATE: 03/01/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/01/2024

LIC9099 (FAS) - (06/04)

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