<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197608029
Report Date: 06/05/2024
Date Signed: 06/05/2024 04:12:25 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
06/04/2024 and conducted by Evaluator Sparkle Day
PUBLIC
COMPLAINT CONTROL NUMBER: 11-AS-20240604111353
FACILITY NAME:VISTA DEL MAR SENIOR LIVINGFACILITY NUMBER:
197608029
ADMINISTRATOR:JANIE ACOSTAFACILITY TYPE:
740
ADDRESS:3360 MAGNOLIA AVENUETELEPHONE:
(562) 595-1559
CITY:LONG BEACHSTATE: CAZIP CODE:
90806
CAPACITY:300CENSUS: 236DATE:
06/05/2024
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Janie AcostaTIME COMPLETED:
04:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff did not allow resident to use a doctor of their choice
Staff did not provide resident medication as prescribed
Staff do not treat resident with dignity or respect
Staff do not respond in a timely manner to resident's call for assistance
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Sparkle Day conducted an “Initial 10-Day” visit to ascertain information pertaining to the above-mentioned allegation(s) and to establish the validity of the complaint. LPA met with Staff #1,Administrator and the purpose of the visit was discussed.

The investigation consisted of the following:
LPA Day obtained copies of the facility's roster for residents and staff. LPA reviewed (R#1) file, including Physicians Report , Admission Agreement , Appraisal/Needs and Service Plan, MARs from March 2024 to May 2024 and Face sheet . LPA interviewed the following: Staff# 1-S6 and Resident #1-6.

The investigation revealed the following:

Allegation: STAFF DID NOT ALLOW RESIDENT TO USE A DOCTOR OF THEIR CHOICE
It is alleged that facility staff did not allow resident to choose her own doctor.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Janae HammondTELEPHONE: (424) 544-1027
LICENSING EVALUATOR NAME: Sparkle DayTELEPHONE: (424) 544-1075
LICENSING EVALUATOR SIGNATURE:

DATE: 06/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/05/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 3
Control Number 11-AS-20240604111353
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: 06/05/2024
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
On 6/5/24 at around 10:00am LPA interviewed S1 - S6 regarding the allegation. 6 out of 6 staff deny the allegations and stated when resident #1 came to the facility an in- house doctor was assigned to the resident, however Resident #1(R1) changed her doctor to a doctor of her choice which is a Kaiser physician

On 6/5/24 at around 11:30 am LPA interviewed R1-R6. 5 of 6 residents informed LPA that they can choose the doctor that they like .

On 6/5/24 at around 12:40pm . LPA interviewed R#1 who informed LPA that she changed her doctor when first came to Vista Del Mar. She changed from a In House doctor of the facility to a Kaiser physician. R#1 still has that Kaiser physician. LPA observed file, medication and appointments from Kaiser for R#1.

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 PROVIDE RESIDENT MEDICATION AS PRESCRIBED

It is alleged that facility staff do not dispense medications correct dosage as prescribed. On 6/5/24 at around 11:30am LPA interviewed the S1 - S5 regarding the allegation. 5 out of 5 staff deny the allegation Staff state the medication is given as listed on the Mars. LPA interviewed R1 who informed LPA of the following: The medication Clorazepam should be given 2 times a day. The medication Sulfurate should be given 5 times daily and the medication Miralax should be given morning and night. On 6/5/2024 during this visit LPA reviewed the Mars of Resident #1 (R1) from March 2024 , when R#1 was admitted (March 2024) to present June 2024 LPA found that the medication dosage is the same and has not changed since the admission of R#1. LPA interviewed R2-R6 all residents deny the allegation and states that their medication is given to them timely and as prescribed..

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 the Allegation - STAFF DO NOT TREAT RESIDENT WITH DIGNITY OR RESPECT

It is alleged that staff do not treat resident with dignity or respect due to the staff do not allow residents to make jokes or use sarcasm .
SUPERVISOR'S NAME: Janae HammondTELEPHONE: (424) 544-1027
LICENSING EVALUATOR NAME: Sparkle DayTELEPHONE: (424) 544-1075
LICENSING EVALUATOR SIGNATURE:

DATE: 06/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/05/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 11-AS-20240604111353
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: 06/05/2024
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
On 6/5/24 at around 1:15 pm LPA interviewed R#1 - R#7 . 6 of 7 residents were consistent in their statements that the facility staff treat them with dignity and respect without question. R#1 informed LPA that due to she said some curse words and staff seemed offended because staff put their hands to their mouth like they had never heard cures words she was not treated with dignity or respect.
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 the Allegation: STAFF DO NOT RESPOND IN A TIMELY MANNER TO RESIDENTS CALL FOR ASSISTANCE
It is alleged that on 6/3/24 residents push their call button and staff did not come. On 6/5/2024 LPA interviewed Staff #4-5 who were on duty 6/3/24. 2 of 2 staff denied the allegation. LPA reviewed the call list of 6/3/24 and 6/4/24 and observed that All buttons pushed between 6/3/24 and 6/4/2024 were answered timely. LPA observed that the call that took the longest time was 12 mins. A button was pushed at 6:09am and the call is reported as complete at 6:21am, meaning they answered and took care of the problem in that time. On 6/5/2024 LPA interviewed 6 residents. 5 of 6 residents were consistent in their statements that the staff respond timely to their calls. Staff state their goal is 10 mins.

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

Exit interview conducted . A copy of this report was left with the Administrator Janie Acosta

SUPERVISOR'S NAME: Janae HammondTELEPHONE: (424) 544-1027
LICENSING EVALUATOR NAME: Sparkle DayTELEPHONE: (424) 544-1075
LICENSING EVALUATOR SIGNATURE:

DATE: 06/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/05/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 3