197608029-4-9-2024-11-AS-JHAD-D5R2KT-20240529172828

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608029
Report Date: 04/09/2024
Date Signed: 04/09/2024 01:34:43 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
04/03/2024 and conducted by Evaluator Perry Scott

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20240403154839

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: 247	DATE:	04/09/2024
		UNANNOUNCED	TIME BEGAN:	09:39 AM
MET WITH:	Janie Acosta		TIME COMPLETED:	01:30 PM

ALLEGATION(S):

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Staff neglected resident resulting in dehydration.

INVESTIGATION FINDINGS:

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On 04/09/24, at 09:30am, Licensing Program Analyst (LPA) Perry Scott conducted a 10-day complaint visit to the facility and was greeted by Janie Acosta, Executive Director. LPA explained the purpose of this visit is to gather information about the complaint and deliver findings for the allegation mentioned above.

The investigation consisted of the following: LPA investigated the allegation mentioned in this complaint; and conducted interviews with staff (S1-S5) and residents (R1-R10). Resident Roster, Staff Roster, ID/Emergency Information, Physicians Report, Unusual Incident Report, & Needs and Service Plan for R1 were obtained from the facility.

The investigation revealed the following: Allegation #1- Staff neglected resident resulting in dehydration.

Report continued on LIC9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (424) 544-1027
LICENSING EVALUATOR NAME: Perry Scott	TELEPHONE: (707) 849-2315
LICENSING EVALUATOR SIGNATURE:	DATE: 04/09/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/09/2024

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-20240403154839

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: 04/09/2024

NARRATIVE

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The details of the complaint alleged that the facility was not monitoring R1’s fluid intake causing R1 to be dehydrated. On 04/09/24, from 10:00am-01:00pm, LPA interviewed staff (S1-S5) and residents (R1-R10) regarding the allegation. R1 could not be interviewed because R1 was in the hospital, however LPA did interview R1’s family member. 5 of 5 staff denied the allegation that the Staff neglected resident resulting in dehydration. All staff (S1-S5) stated that they did not neglect R1 in any way. They stated that R1 would get fluids with each of R1’s three meals and that R1 had about six cases of water in R1’s room, that was not restricted in any way. S1-S5 stated that R1 was an independent resident and could eat and drink by R1’s self. They further stated that R1 would get monitored throughout the day and that R1 seemed to be doing okay, until one day R1 seemed to have confusion and was lethargic; 911 was called on 03/25/24 and R1 was admitted to the hospital. S3 stated that R1 was very independent and did not want to be bothered but whenever S3 would take R1’s food and drink, R1 would eat and drink and did not seem to have any issues. R1’s family member stated that R1 was dehydrated and was malnourished when R1 entered the hospital and was not sure if staff were monitoring R1’s food and water intake.

LPA took a tour of R1’s room and observed that the resident had six cases of water and several bags of empty water bottles in R1’s room. LPA interviewed residents R1-R10 about the allegation that Staff neglected resident resulting in dehydration. 9 of 10 residents that were interviewed denied the allegation and stated that the staff gives them enough food and fluids throughout the day and that they are happy with their care and supervision provided by the staff.

Based on interviews, there is insufficient evidence to support the allegation that the Staff neglected resident resulting in dehydration. 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.

No deficiencies were cited.

An exit interview was conducted with Janie Acosta, Administrator, and a copy of this report was provided.

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (424) 544-1027
LICENSING EVALUATOR NAME: Perry Scott	TELEPHONE: (707) 849-2315
LICENSING EVALUATOR SIGNATURE:	DATE: 04/09/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/09/2024

LIC9099 (FAS) - (06/04)

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