197608029-5-22-2024-11-AS-MVAO-D5QVN7-20240529163439

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608029
Report Date: 05/15/2024
Date Signed: 05/22/2024 11:46:03 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, 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
05/07/2024 and conducted by Evaluator Sparkle Day

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20240507095441

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: 245	DATE:	05/15/2024
		UNANNOUNCED	TIME BEGAN:	10:24 AM
MET WITH:	Sidonia Cordis Karen Ashley		TIME COMPLETED:	04:45 PM

ALLEGATION(S):

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Staff did not assist resident with obtaining prescribed medication
Staff did not administer resident's medication as prescribed

INVESTIGATION FINDINGS:

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On 5/15/24 at 10:24 am, Licensing Program Analyst (LPA) Sparkle Day conducted the initial10 day Complaint visit to ascertain information pertaining to the above-mentioned allegation(s) and to establish the validity of the complaint. LPA met with Staff #1,(Resident care Director), S#2(Health Services Director) and S#3(Executive Director) who assisted with the visit.

Todays investigation consisted of the following: LPA Day obtained copies of the facility's roster for residents and staff. LPA reviewed (R#1) - (R#10) files, including Physicians Report , Admission Agreement , Appraisal/Needs and Service Plan, MARs and Face sheet . LPA interviewed the following: R1- R8, Staff 1-S7 and witness #1(W-1).
The investigation revealed the following:
Allegation: STAFF DID NOT ASSIST RESIDENT WITH OBTAINING PRESCRIBED MEDICATION
t is alleged that facility staff did not order a medication for resident and facility staff refused to pick up the medication.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (424) 544-1027
LICENSING EVALUATOR NAME: Lizeth Villegas	TELEPHONE: (424) 544-1075
LICENSING EVALUATOR SIGNATURE:	DATE: 05/15/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/15/2024

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-20240507095441

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: 05/15/2024

NARRATIVE

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On 5/15/24 at around 10:40am LPA interviewed the Executive Director and Health Services Director regarding the allegation, Executive Director and Health Services Director denied the allegations and stated when resident #1 came to the facility an in- house doctor was assigned to the resident so that so that the previous medication that was being given to resident 1 could continue. Health Services Director explained due to medication being considered a controlled substance it could not follow resident #1 from last placement. The exact date is not known but shortly after Resident #1 switched health care to Kaiser without the knowledge of any of Vista Del Mar staff until they were requesting the medication. Staff were told that resident 1 was not a patient of theirs and would not be refilling the medication. Staff were not able to get medication from their pharmacy. Staff 3 (Health Director ) then called Kaiser for medication and was told, due to medication being a control substance the resident would have to be seen before medication refilled. On 5/15/24 between 11:45am - 1:00pm LPA interviewed 9 of 10 residents who were consistent in their statements that the facility staff has assisted with obtaining their medications regularly without failure. On 5/15/23, LPA interviewed Staff 1-S7 regarding the allegation. 7 of 7 staff interviewed denied the allegation. LPA conducted a file review and information obtained wad consistent with Facility staff interviews.

Based upon this investigation, LPA finds that 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

Regarding Allegation - STAFF DID NOT ADMINISTER RESIDENT'S MEDICATION AS PRESCRIBED

It is alleged that facility staff do not dispense medication on a timely basis. This medication is supposed to be dispensed one hour before meals and it’s dispensed during or after meals. On 5/15/24 at around 11:30am LPA interviewed the Med Tech Supervisor(S4) regarding the allegation ,S4 denied the allegation and stated resident 1 has a medication that is to be given an hour before dinner, however although staff is there to give it on time, there are times when the medication is refused by resident 1 and the Mars is the receipt of the days refused. On 5/15/24 around 11:45 am LPA interviewed 6 of 6 staff regarding the allegation. 6 of 6 staff denied the allegation. On 5/15/24 during this visit LPA Day observed The MARs of Resident 1 were resident #1 refused timely medication seven (7) times.

An exit interview was conducted a copy of this report was left with the Executive Director.

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (424) 544-1027
LICENSING EVALUATOR NAME: Lizeth Villegas	TELEPHONE: (424) 544-1075
LICENSING EVALUATOR SIGNATURE:	DATE: 05/15/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/15/2024

LIC9099 (FAS) - (06/04)

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