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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197608029
Report Date: 02/20/2025
Date Signed: 02/20/2025 03:28:22 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
02/12/2025 and conducted by Evaluator Lizeth Villegas
COMPLAINT CONTROL NUMBER: 11-AS-20250212143057
FACILITY NAME:VISTA DEL MAR SENIOR LIVINGFACILITY NUMBER:
197608029
ADMINISTRATOR:SUZETTE S. JOHNSONFACILITY TYPE:
740
ADDRESS:3360 MAGNOLIA AVENUETELEPHONE:
(562) 595-1559
CITY:LONG BEACHSTATE: CAZIP CODE:
90806
CAPACITY:300CENSUS: 240DATE:
02/20/2025
UNANNOUNCEDTIME BEGAN:
08:52 AM
MET WITH:Executive Director Suzette JohnsonTIME COMPLETED:
01:15 PM
ALLEGATION(S):
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Facility memory care unit is not properly staffed.
INVESTIGATION FINDINGS:
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On 02/20/25 Licensing program analyst (LPA) Villegas conducted an unannounced initial compaint visit regarding the allegation above. LPA met with Executive Director Suzette Johnson as the purpose of the meeting was explained.

The investigation consisted of the following: On 02/20/25 LPA obtained copies of the following: resident and staff rosters, memory care staff time cards, and memory care schedules for the month of February 2025 and March 2025. On 02/20/25 LPA conducted a tour of the facility and there were no health and safety concerns.
On 02/20/25 from 10am-11am LPA conducted interviews with staff #1-4 (S1-S4), and from 11:15 am to 12:45pm interviews were conducted with R1-R6.

The investigation revealed the following:
Allegation: Facility memory care unit is not properly staffed.
It is being alleged that resident falls are a result of insufficient staffing in the Memory Care unit.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Lizeth Villegas
LICENSING EVALUATOR SIGNATURE:

DATE: 02/20/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/20/2025
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 2
Control Number 11-AS-20250212143057
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: 02/20/2025
NARRATIVE
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On 02/20/25 from 10am-11am LPA conducted interviews with (S1-S4) regarding the allegation above, 4 of 4 staff interviewed denied the allegation above. Per 1 of 4 staff interviewed, the facility works with a registry/agency if there is a shift that needs to be covered. On 02/20/25 from 11:15 am to 12:45pm LPA conducted interviews with R1-R6, 4 of 6 residents denied the allegation above, 2 of 6 residents interviewed reported experiencing an un-witnessed falls in the past. 6 of 6 residents reported feeling safe when assisted by staff. On 02/20/25 LPA conducted a review of memory care staff time cards and schedules, LPA observed that there is a total of 42 memory care residents which are split into 4 groups daily. LPA observed memory care to have 6 staff for the morning, 4 staff in the evening shifts, and 2 staff for NOC shift.

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 interviewed conducted, and a copy of this report was provided.
SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Lizeth Villegas
LICENSING EVALUATOR SIGNATURE:

DATE: 02/20/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/20/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2