197608029-4-30-2025-11-AS-SCIS-DM4TPX-20251003145459

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608029
Report Date: 04/28/2025
Date Signed: 04/30/2025 11:10:33 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, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/21/2025 and conducted by Evaluator Pamela Bunker

COMPLAINT CONTROL NUMBER: 11-AS-20250421123647

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: 246	DATE:	04/28/2025
		UNANNOUNCED	TIME BEGAN:	09:26 AM
MET WITH:	Suzette Johnson		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

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Staff do not ensure residents dietary care plan is being followed
Staff do not ensure resident is provided with breakfast, lunch and dinner each day
Staff does not ensure adequate care and supervision is provided to residents

INVESTIGATION FINDINGS:

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On 04/28/2025 at 9:26 a.m., The Department conducted an initial visit to gather information regarding the above allegations. The Department met with Executive Director Suzette Johnson and explained the purpose of today's visit. LPA was granted entry to the facility.

Investigation consisted of the following: On 04/28/2025, the department requested, reviewed and obtained copies of Resident Roster (Dated 04/28/2025), Personnel Report (Dated 04/28/2025), Dietitian's Report (Dated 03/28/2025) Weekly Menu (Dated 02/16/2025 - 05/03/2025) Resident 1's Records (Dated 04/28/2025) Resident 1's Progress Note (Dated 06/01/2024 - 04/28/2025), and Tray Service Request. Interviews were conducted, with staff 1-2 (S1-S2) and residents 1-10 (R1-10). We toured the facility kitchen. At 11:30 a.m., the Department observed residents eating well-balanced and nutritious meals. We observed an ample supply of nonperishable foods for a minimum of one week and fresh perishable foods for a minimum of two days.
See continued LIC9099-C page 2

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Pamela Bunker
LICENSING EVALUATOR SIGNATURE:	DATE: 04/28/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/28/2025

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-20250421123647

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: VISTA DEL MAR SENIOR LIVING	FACILITY NUMBER: 197608029
	VISIT DATE: 04/28/2025

NARRATIVE

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Continued LIC9099-C page 2
Investigation revealed the following:
On 04/21/2025, it was alleged that a resident was unable to eat the food served due to the resident's dietary restrictions. It was reported that the facility maintains a record of residents’ special dietary needs; however, it does not consistently follow them. It was also reported that the facility does not have a dietitian. The facility does not provide substitutions that residents can eat on a regular basis. Although the facility uses meal menu slips for residents who are unable to make their way to the dining hall, staff have at times forgotten to pick up residents’ meal slips from their rooms, resulting in residents not receiving meals on multiple occasions. It was reported that on 04/20/2025 at 9:30 p.m., a male resident with dementia entered a resident’s room without permission while the resident was sleeping. The resident woke up, yelled at the male resident to leave, and pressed the pendant for assistance. The staff responded within three minutes and removed the male resident.

Allegation: Staff do not ensure residents' dietary care plan is being followed.
On 04/28/2025, the Department interviewed staff members 1-2 (S1-S2) and residents 1-10 (R1-R10) regarding the allegation. Staff members (2 out of 2) and 9 out of 10 residents stated staff does ensure residents' dietary care plans are being followed. They confirmed that staff consistently adhere to the physician-prescribed dietary menu, and residents are served well-balanced, nutritious meals according to the doctors' orders. S1-S2 and R2-R10 stated that the facility does have a dietitian. R1 stated that staff do not ensure residents' dietary care plan is being followed. S1-S2 and R2-R10 all denied the allegation.

Allegation: Staff do not ensure the resident is provided with breakfast, lunch, and dinner each day.
On 04/28/2025, the Department interviewed staff members 1-2 (S1-S2) and residents 1-10 (R1-R10) regarding the allegation. Staff members (2 out of 2 ) and 9 out of 10 residents stated staff does ensure the residents are provided with breakfast, lunch, dinner, and snacks. Residents confirmed they receive three meals per day, alternative food choices are offered. The facility provides a diverse range of food options, and if a resident requests a second serving, staff accommodates the request. R2-R10 stated they receive plenty of food to eat, and if they don't want to dine in the dining lounge, they can complete a tray service request. Staff will collect the request slip and deliver the meal to the resident's room. R1 stated that staff do not ensure residents are provided with breakfast, lunch, and dinner each day. S1-S2 and R2-R10 all denied the allegation.
See continued LIC9099-C page 3

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Pamela Bunker
LICENSING EVALUATOR SIGNATURE:	DATE: 04/28/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/28/2025

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 11-AS-20250421123647

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: VISTA DEL MAR SENIOR LIVING	FACILITY NUMBER: 197608029
	VISIT DATE: 04/28/2025

NARRATIVE

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Continued LIC9099-C page 3
Allegation: Staff do not ensure adequate care and supervision is provided to residents
On 04/28/2025, between 10:00 a.m. and 11:30 a.m., the Department interviewed two staff members #1 and #2 (S1-S2), regarding the allegation. S2 stated that a resident reported another resident had entered their room; however, there were no witnesses to the incident, and a review of the facility’s surveillance cameras did not reveal any unauthorized entry. Maintenance checked the resident's door and confirmed it was in operable condition. S1 and S2 explained that care staff conduct Wellness checks on residents every two hours. All residents have pendants and call buttons to alert staff if they need assistance. Staff confirmed that no unauthorized individuals were observed entering residents’ rooms. S1 and S2 stated residents’ doors remain locked, and each resident has a personal key to their own room. S1-S2 states the facility currently has about 93 staff members employed and is fully staffed, and that residents are receiving appropriate care, supervision, and assistance with their daily needs. Both interviewed staff (2 out of 2) confirmed the facility is sufficiently staffed and denied the allegation.
On April 28, 2025, between 11:45 a.m. and 12:00 p.m., the Department reviewed the facility’s Personnel Report (LIC 500), which listed the following staff positions: Executive Director; Human Services Director; Vice President of Operations; Business Office Manager; Human Resources Director; Resident Care Director; ALW Coordinator; 4 Licensed Vocational Nurses (LVNs); 2 Community Liaisons; 2 Maintenance Staff; 4 Cooks; 5 Kitchen Staff; 4 Food Servers; 2 Dishwashers; 6 Dietary Aides; 9 Medication Technicians; 7 Memory Care Caregivers; 1 Memory Care Activity Director; 2 Activities Assistants; 25 Caregivers; 7 Housekeepers; 4 Receptionists; and 1 Driver a total number of employees listed: 93, confirmed the facility is adequately staffed.
On April 28, 2025, between 12:00 p.m. and 2:30 p.m., on the same day, the Department conducted interviews with ten residents #1-#10 (R1–R10) regarding the allegation of inadequate care and supervision. 9 out of 10 residents stated that the facility is adequately staffed and confirmed they are receiving the necessary care and supervision. 9 out of 10 also stated that staff are consistently present every shift. 1 out of 10 residents expressed concern about staffing and did not feel care and supervision were adequate. 9 out of 10 residents reported that they were happy living at the facility and had no problems or complaints. The majority of residents (9 out of 10) denied the allegation and stated that their daily needs were being met.
Based on interviews, available evidence, observation, information received, and records reviewed there was not enough sufficient evidence to support the allegations. 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 deemed unsubstantiated. There were no deficiencies cited. An exit interview was conducted.

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Pamela Bunker
LICENSING EVALUATOR SIGNATURE:	DATE: 04/28/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/28/2025

LIC9099 (FAS) - (06/04)

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