197608029-3-13-2024-11-AS-RORN-D3KKRF-20240321080750

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608029
Report Date: 03/13/2024
Date Signed: 03/13/2024 02:23:17 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
11/18/2022 and conducted by Evaluator Felisa Shirley

COMPLAINT CONTROL NUMBER: 11-AS-20221118101001

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: 248	DATE:	03/13/2024
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Excutive Director, Janie Acosta		TIME COMPLETED:	02:30 PM

ALLEGATION(S):

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Staff is not preventing the spread of scabies
Staff are not preventing resident from engaging in inappropriate behaviors

INVESTIGATION FINDINGS:

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On 3/13/24 Licensing Program Analyst (LPA) Felisa Shirley, conducted a subsequent unannounced complaint visit to the address listed above. LPA arrived at and spoke to Executive Director Janie Acosta and the purpose of the visit was discussed. LPA was granted access to the facility.

The investigation consisted of the following: On 11/28/22 Pamela Bunker conducted an unnanounced visit and interviewed then Executive Director Reggie Jones. Due to insufficient information available at that time, a needs further investigation was done. On 2/29/24 LPA Felisa Shirley reviewed both Staff and Resident files and toured the facility. LPA requested and received copies of the following: ID and Emergency Information, Preplacement Appraisal Information, Admission Agreement, Appraisal/Needs and Services Plan, Physician’s Report, Incident reports, Assessments, and Response to Public Health notice.
The investigation revealed the following:

Con'd on 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Stephanie Cifuentes	TELEPHONE: (661) 644-7743
LICENSING EVALUATOR NAME: Felisa Shirley	TELEPHONE: 323-981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 03/13/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/13/2024

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-20221118101001

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: 03/13/2024

NARRATIVE

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Allegation: Staff is not preventing the spread of scabies

On 3/13/24 LPA Shirley reviewed resident’s files and incident reports. LPA observed 2 incident reports that were sent to CCLD for scabies. The first report indicated there to be one incident that occurred 6/9/22, reported 6/14/22. Assessment of all the residents in Memory care unit proved signs of possible scabies on a few other residents. The Physician was notified, the community was locked down and quarantined. All residents were treated for possible scabies. Family, POA and Public health were all notified. LPA observed the second report that indicated a scabies outbreak in Memory Care unit that occurred 3/28/23. Four residents were diagnosed and treated for scabies. Measures were put into place to help mitigate the spread and keep it contained. Families and public health were notified. LPA reviewed response from public health in which guidance on Outbreak Management was provided along with an attached Scabies Toolkit.

On 2/29/24 LPA Shirley interviewed Staff 1 – Staff 10 (S1-S10). LPA asked, did residents in the Memory Care unit have scabies? Of those interviewed, 5 out of 10 answered yes. LPA asked residents, did you know about an outbreak of scabies. Of those interviewed, 10 out of 10 was not aware of an outbreak.

Based on information gathered, the department did not find sufficient evidence to support allegation "Staff is not preventing the spread of scabies.” This facility was not negligent, residents were tested and public health was contacted as is protocol. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is Unsubstantiated.

Allegation: Staff are not preventing residents from engaging in inappropriate behaviors

It was reported that a resident from the assisted living side of the facility digs in the trash and the dog disposal and takes things out the trash and touches things within the facility.

On 3/13/24 LPA Shirley reviewed resident’s file, which included yearly Appraisal/Needs and services plans and assessments. Upon review of documents, LPA observed that R1 has had this behavior their whole life and that their behavior has been documented on several needs and services plans and also provided what precautions that the staff were taking. Resident was moved from the assisted living side and placed in the Memory Care Unit of this facility.

Con'd on 9099-C

SUPERVISOR'S NAME: Stephanie Cifuentes	TELEPHONE: (661) 644-7743
LICENSING EVALUATOR NAME: Felisa Shirley	TELEPHONE: 323-981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 03/13/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/13/2024

LIC9099 (FAS) - (06/04)

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Control Number 11-AS-20221118101001

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: 03/13/2024

NARRATIVE

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On 2/29/24 LPA Shirley interviewed Staff 1 – Staff 10 (S1-S10). LPA asked, did a resident from the assisted living side dig in the trash every day which also contained a dog disposal in the trash can? Of those interviewed, 8 out of 10 answered yes. LPA asked residents, have you ever seen a resident that use to dig in the trash everyday? Of those interviewed, only 2 out of 10 remembered the incident and answered yes.

Based on information gathered and interviews conducted, the department did not find sufficient evidence to support the allegation, staff are not preventing residents from engaging in inappropriate behaviors. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is Unsubstantiated.

An exit interview was conducted and a copy of the LIC 9099 was provided to Executive Director Janie Acosta.

SUPERVISOR'S NAME: Stephanie Cifuentes	TELEPHONE: (661) 644-7743
LICENSING EVALUATOR NAME: Felisa Shirley	TELEPHONE: 323-981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 03/13/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/13/2024

LIC9099 (FAS) - (06/04)

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