197608029-2-5-2025-11-AS-JHAD-DDRUJ3-20250210143651

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608029
Report Date: 02/05/2025
Date Signed: 02/05/2025 03:38:39 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
01/27/2025 and conducted by Evaluator Perry Scott

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20250127155801

FACILITY NAME:	VISTA DEL MAR SENIOR LIVING		FACILITY NUMBER:	197608029
ADMINISTRATOR:	SUZETTE S. JOHNSON		FACILITY TYPE:	740
ADDRESS:	3360 MAGNOLIA AVENUE		TELEPHONE:	(562) 595-1559
CITY:	LONG BEACH	STATE: CA	ZIP CODE:	90806
CAPACITY:	300	CENSUS: 239	DATE:	02/05/2025
		UNANNOUNCED	TIME BEGAN:	01:31 PM
MET WITH:	Suzette Johnson		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

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Facility staff did not provide resident with a bedroom chair.

INVESTIGATION FINDINGS:

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On 2/05/25, at 1:30pm, Community Care Licensing Division (CCLD) Staff conducted an initial complaint visit to the facility and was greeted by Suzette Johnson, Executive Director. CCLD explained the purpose of this visit is to gather information about the complaint, interview staff and residents, and deliver findings for the allegation mentioned above.

The investigation consisted of the following: An initial complaint visit was completed by (CCLD) staff on 2/05/2025. The department investigated the allegation mentioned in this complaint; and conducted interviews with staff (S1-S4) and residents (R1-R10). Resident Roster (Dated: No Date) and Staff Roster (Dated: 2/05/2025) were obtained from the facility.

The investigation revealed the following: Allegation- Facility staff did not provide resident with a bedroom chair.

Report Cpontinued On LIC9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Perry Scott
LICENSING EVALUATOR SIGNATURE:	DATE: 02/05/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/05/2025

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-20250127155801

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: 02/05/2025

NARRATIVE

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The details of the complaint alleged that the facility does not provide the required personal accommodations to residents. It is alleged that residents are not provided a chair in their room per Title 22 regulations. On 02/05/25, from 1:00pm-3:00pm, the department interviewed staff (S1-S4) and residents (R1-R10) regarding the allegation. 4 of 4 staff denied the allegation that the Facility staff did not provide resident with a bedroom chair. All staff (S1-S4) interviewed stated that the facility does provide the required items per Title 22 regulations. S1-S4 stated that when a resident moves in they are provided with a bed, nightstand, chair, lamp, and dresser. Staff also stated that sometimes a resident brings their own furniture, but the option is still available to them if they need it. S1 stated that one resident recently asked if they could provide them with a gamer chair in their room. S1 stated no because the facility does not offer that kind of chair but could provide the resident with a standard chair. S1 stated the resident was not happy and wanted the gamer chair.

The department interviewed residents (R1-R10) about the allegation and 9 of 10 residents that were interviewed denied the allegation that Facility staff did not provide resident with a bedroom chair. The majority of the residents (9 of 10) stated that they did not have a problem with the facility. 4 of 9 residents stated that they brought their own furnishings with them when they moved in and 5 of 9 residents stated that the facility did provide them with a chair and the other furnishings for their bedroom.

The department toured the facility and observed bedrooms # 109, 116, 118, 137, 138, 242, 245, 271A, 271B and 293; and all rooms had the required furnishings per Title 22 regulations.

Based on interviews conducted, there is insufficient evidence to support the allegation that the Facility staff did not provide resident with a bedroom chair. 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 citations were issued on this complaint visit.

An exit interview was conducted, and a hard copy of this Complaint Investigation Report was provided to Suzette Johnson, Executive Director.

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Perry Scott
LICENSING EVALUATOR SIGNATURE:	DATE: 02/05/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/05/2025

LIC9099 (FAS) - (06/04)

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