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

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197608029
Report Date: 05/01/2025
Date Signed: 05/01/2025 05:06:04 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
04/28/2025 and conducted by Evaluator Ernand Dabuet
PUBLIC
COMPLAINT CONTROL NUMBER: 11-AS-20250428095622
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: 246DATE:
05/01/2025
UNANNOUNCEDTIME BEGAN:
08:32 AM
MET WITH:Suzette JohnsonTIME COMPLETED:
04:29 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff does not provide comfortable water temperature for resident(s).
Staff does not keep resident’s room free from pests.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On May 1, 2025, the California Department of Social Services Community Care Licensing (CDSS/CCL) Licensing Program Analyst (LPA) Ernand Dabuet conducted an initial unannounced visit to gather information regarding the above allegations. LPA met with Executive Director Suzette Johnson, and explained the purpose of the visit. LPA was granted entry to the facility.

The investigation consisted of Interviews, a collection of records, and a tour of the facility. Interviews were conducted with staff members #1-#5 (S1 to S5), and resident members #1-#10 (R1 to R10). List of documents reviewed/obtained Resident Roster (dated 05/01/25), Personnel Report LIC 500 (dated 05/01/25), Dewey Pest Control Service Agreement (dated 12/12/24),Dewey Pest Control Service Log (dated 04/01/25 through 04/29/25), and other documents pertinent with this complaint.

(Evaluation Report continues LIC 9099C)
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ernand Dabuet
LICENSING EVALUATOR SIGNATURE:

DATE: 05/01/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/01/2025
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 4
Control Number 11-AS-20250428095622
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: 05/01/2025
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
INVESTIGATION REVEALED THE FOLLOWING:

Allegation #1: Staff does not provide comfortable water temperature for resident(s).

The complaint details the staff allegedly failing to provide a comfortable water temperature for residents in care. Reports indicate that there is no hot water available. The common shower area fails to provide consistent hot water, and despite notifying a staff member about this issue, no actions have been taken to resolve it, and no further information has been provided.

On May 1, 2025, between 9:30 AM and 10:30 AM, the Department interviewed staff members identified as Staff #1 through Staff #5 (S1-S5). Five (5) out of the (5) staff members could not validate this allegation. (S1-S2) acknowledged since April 22, 2023, there have been some issues with the water pressure due to one of the boilers that operates by gas not operating correctly. (S1) notified Community Care Licensing (CCL) by submitting an incident report on April 23, 2025. (S1) provided a subsequent report to (CCL) on April 26, 2025, written notification to Residents and Families of Vista Del Mar Senior Living of Hot Water Service Disruption for the first and second floors. In the notice that it described, the HVAC contractor and Southern California Gas have been working to identify and resolve problems with the facility’s boiler system. The notice offered temporary accommodations with vacant rooms and common area shower rooms for residents affected by this problem. (S2) stated that all rooms have access to hot water because there is still one operational boiler. This boiler effectively transfers heat to the water by passing it through a pipe within the heated gas chamber. Consequently, while the water may take slightly longer to heat up, it remains universally available in every room. Utilizing two separate boilers enables a quicker heat transfer process that residents recognize. Staff member #3 (S3) stated that (S3) does not recall discussing the hot water issues with residents. Additionally, (S3) indicated that no residents have reported any concerns related to this matter.

On May 1, 2025, between 10:35 AM and 12:00 PM, the Department interviewed resident members identified as Resident #1 through Resident #10 (R1-R10). Ten (10) out of the ten (10) resident members could not corroborate this allegation. (R1-R10) have access to running hot water in their rooms. Five (5) out of the ten (10) residents acknowledged receipt of the written notification regarding alternative amenities.

(Evaluation Report continues LIC 9099-C)

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ernand Dabuet
LICENSING EVALUATOR SIGNATURE:

DATE: 05/01/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/01/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 11-AS-20250428095622
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: 05/01/2025
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 May 1, 2025, between 1:30 PM and 2:30 PM, the Department conducted inspections of rooms #105, #117, #235, #236, #237, #238, and #239, as well as the kitchen and public restrooms. During the inspection, heated water was available, with temperatures ranging from 105.1°F to 118.0°F, which complies with Title 22 Regulations. Additionally, the Department observed the HVAC technician servicing the boiler systems.

The Department also reviewed written communication reports dated April 23, 2025, and April 26, 2025, which indicated that the facility is taking proactive measures to address the boiler system issue.

Based on the information gathered, there is not enough evidence to support the allegation mentioned above.

Allegation #2: Staff does not keep resident’s room free from pests.

The staff allegedly neglected to ensure that the residents were free from pests. Three cockroaches were reportedly found in a resident's room. Although a staff member was notified about the issue, no action has been taken to address it, and no further details have been provided.

On May 1, 2025, between 9:30 AM and 10:30 AM, the Department interviewed staff members identified as Staff #1 through Staff #5 (S1-S5). Five (5) out of the (5) staff members expressed no pest activity in the facility, including resident’s rooms. (S1-S2) emphasizes its commitment to ensuring the safety and well-being of residents by implementing effective, environmentally friendly pest management measures. Their proactive approach protects their residents and promotes a healthier living environment for everyone. The facility has an active Service Agreement with a reputable pest control company that performs weekly routine pest control services. (S2) stated that these scheduled services are done every Tuesday and will treat 10 rooms and common areas weekly. Staff member #3 (S3), referenced in this complaint, indicated that (S3) do not remember conversing with residents regarding pest control issues.

On May 1, 2025, between 10:35 AM and 12:00 PM, the Department interviewed resident members identified as Resident #1 through Resident #10 (R1-R10). Ten (10) out of the ten (10) resident members could not validate this allegation. All residents from (R1-R10) have stated that they have not encountered any pests within their rooms or in the facility's common areas. Additionally, they have observed pest control professionals actively performing treatments throughout the premises, ensuring a safe and pest-free environment for everyone.

(Evaluation Report continues LIC 9099-C)

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ernand Dabuet
LICENSING EVALUATOR SIGNATURE:

DATE: 05/01/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/01/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 11-AS-20250428095622
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: 05/01/2025
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 May 1, 2025, between 1:30 PM and 2:30 PM, the Department conducted inspections of rooms #105, #117, #235, #236, #237, #238, and #239, as well as the kitchen, activity rooms, and dining room. Upon inspection, no signs of pest activity were present in the area.

The Department also reviewed a Dewey Pest Control Service Agreement dated December 12, 2024, which provided valid proof of an annual service contract. This contract indicated that ten units of service were performed monthly, totaling 40 treatments per month. Additionally, a review of the Dewey Pest Control Service Log, covering the period from April 1, 2025, to April 29, 2025, confirmed that treatment services are being performed weekly.

Based on the information gathered, there is not enough evidence to support the allegation mentioned above.

Based on the information collected from the facility inspection, observations, interviews, and records analysis, the Department found no evidence to support the above allegations. While the allegations may be valid or have occurred, there is insufficient evidence to establish whether the alleged violations took place or did not. Therefore, the allegations are determined Unsubstantiated.

An exit interview with Executive Director, Suzette Johnson and reports were provided.

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ernand Dabuet
LICENSING EVALUATOR SIGNATURE:

DATE: 05/01/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/01/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 4