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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197608029
Report Date: 04/04/2025
Date Signed: 04/04/2025 10:21:29 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
12/26/2024 and conducted by Evaluator Perry Scott
PUBLIC
COMPLAINT CONTROL NUMBER: 11-AS-20241226135225
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: 242DATE:
04/04/2025
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Suzette JohnsonTIME COMPLETED:
11:00 AM
ALLEGATION(S):
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Resident had unknown exposure to fentanyl while in care.
INVESTIGATION FINDINGS:
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On 12/31/2024, at 9:25am, the department made an unannounced initial visit to the facility and was greeted by Suzette Johnson, Administrator (S1). The purpose for today’s visit was to obtain facility files pertaining to the above-mentioned allegation.

The investigation consisted of the following: On 12/31/24 the department conducted an initial visit and met with Administrator, Suzette Johnson (S1). A subsequent visit was completed by the department on 04/4/2025. During the initial visit, the department conducted a tour of the facility’s physical plant and observed residents in care. The department obtained copies of the following documents: Resident Roster (No Date), Staff Roster (Dated: 12/31/2024), and In-Service Medication Training for Staff (Dated: 10/18/2023-11/05/2024) for the facility. Records for resident (R1): ID/Emergency Information (Dated: 12/31/24) Admission Agreement (Dated:09/06/2024), Appraisal & Needs Service Plan (Dated: 09/18/2024), Physicians Report (Dated: 07/24/2024), After Visit Summary (Dated: 12/24/2024), Unusual Incident/Injury Report (Dated: 12/20/24 & 12/31/2024).....

Page 1 of 3 LIC9099
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Perry Scott
LICENSING EVALUATOR SIGNATURE:

DATE: 04/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/04/2025
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 3
Control Number 11-AS-20241226135225
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: 04/04/2025
NARRATIVE
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Medication Administration Records (Dated: 10/01/2024-12/31/2024), and current Physician’s Orders (Dated: 12/31/2024) were also obtained from the facility. This complaint was referred to the California Department of Social Services Investigation Bureau for investigation and was assigned to Investigation Bureau Investigator, Olivia Spindola.

As a part of the investigation, Investigator Spindola subpoenaed copies of College Medical Center medical records for resident (R1) which included: progress notes, physicians orders, psychological exam, lab results, and medication list. Additionally, the investigator conducted interviews with staff (S1-S4), witness (W1), and residents (R1-R3).

The investigation revealed the following: Allegation-Resident had unknown exposure to fentanyl while in care.

It is alleged that resident had exposure to an illegal drug while living at the facility. On 12/18/24 the resident was admitted to College Medical Center where they tested positive for the illegal drug Fentanyl. On 01/15/25, from 11:30am-1:00pm, the department interviewed staff (S1-S3); On 2/11/25, from 11:00am-3:30pm, the department interviewed residents (R1-R3) and staff (S4), and on 3/18/25, from 4:00pm-4:30pm, the department interviewed witness (W1) about the complaint allegation. 4 of 4 staff denied the allegation that the Resident had unknown exposure to fentanyl while in care. Staff denied knowing how the resident tested positive for the illegal drug. Staff also stated the resident resides in a locked area and cannot leave without supervision or assistance from staff. They further deny that the resident had access to illegal narcotics inside the facility or that anyone would provide the resident with Fentanyl.

The department interviewed residents (R1-R3) about the allegation and 2 of 3 residents denied the allegation, while one resident was unable to participate in the investigation due to poor health. The residents that were interviewed stated that they have not witnessed any illegal drug use in the facility and was not aware of anyone providing illegal narcotics to residents.

The department reviewed medical records from College Medical Center for R1 and observed that (R1) tested positive for Fentanyl on 12/18/2024, and 12/31/2024, when hospitalized at College Medical Center (CMC). The CMC records revealed that (R1) was hospitalized on an involuntary psychiatric hold for reported increased aggression and combativeness. Although the medical records indicated (R1) tested positive for Fentanyl during both hospitalizations, the department did not uncover any evidence or obtained any witness statements indicating that (R1) had access to Fentanyl or any other illegal narcotics, as (R1) resides in the Memory Care Unit of the facility, which is a locked area. The CMC records also indicated that (R1) takes several psychotropic medications to treat schizoaffective disorder, which included Olanzapine, Risperidone, Lorazepam, Quetiapine, and Trazadone. According to www.pubmed.ncbi.nlm.nih.gov, antibiotics, analgesics, and antidepressants medications such as Quetiapine and Risperdal are known to give false-positive for Fentanyl in laboratory testing. The nurse assistant (W1) stated that Quetiapine and Risperidone are drugs known to give false-positive for Fentanyl.



Page 2 of 3 LIC9099-C
SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Perry Scott
LICENSING EVALUATOR SIGNATURE:

DATE: 04/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/04/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 11-AS-20241226135225
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: 04/04/2025
NARRATIVE
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Based on records reviewed and interviews conducted, there is insufficient evidence to support the allegation that the Resident had unknown exposure to fentanyl while in care. 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 for this complaint.

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

Page 3 of 3 LIC9099-C

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Perry Scott
LICENSING EVALUATOR SIGNATURE:

DATE: 04/04/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/04/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3