197608029-10-23-2024-11-AS-RORN-DBMUZN-20241204150148

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608029
Report Date: 10/23/2024
Date Signed: 10/23/2024 05:39:37 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, 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
10/15/2024 and conducted by Evaluator Wendy Gibbs

COMPLAINT CONTROL NUMBER: 11-AS-20241015140936

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: 243	DATE:	10/23/2024
		UNANNOUNCED	TIME BEGAN:	02:53 PM
MET WITH:	Suzette Johnson		TIME COMPLETED:	05:40 PM

ALLEGATION(S):

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Staff do not answer resident's calls for assistance
Staff do not ensure facility is free from pests
Staff do not maintain facility in good repair.

INVESTIGATION FINDINGS:

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On 10/23/24, Licensing Program Analysts (LPA), Wendy Gibbs and Perry Scott, conducted an unannounced complaint visit. During the visit the Department met with Executive Director, Suzette Johnson, and the purpose of today’s visit was explained.

During today’s visit the Department conducted a facility inspection, interviewed Staff S1-S8, interviewed Residents R1-R11, and received documents pertinent to the investigation. The following documents were received and reviewed Resident Roster, Staff Roster, pest control receipts from Terminix, and Work Orders.

The investigation revealed the following:

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Wendy Gibbs	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 10/23/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/23/2024

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 11-AS-20241015140936

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: 10/23/2024

NARRATIVE

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Allegation: Staff do not answer resident’s calls for assistance.
The complaint allegation alleges that the facility staff do not always answer calls for help or assistance.
During the facility inspection, the Department tested resident call buttons in rooms 111, 205, 242, and 316. The Department timed how long it took for a caregiver to answer the call for assistance and the following times were recorded 6 minutes, 5 minutes, 6 minutes, and 8 minutes.
During interviews with Staff S1 – S8, were asked how long it takes to respond to a resident’s call for assistance, eight (8) out of eight (8) stated they respond to residents calls for assistance in less than 10 minutes.
During interviews with Residents R1-R11, were asked how long it takes staff to respond to their calls for assistance, seven (7) out of eleven (11) stated the staff come right away when called. Additionally, Residents R1-R11 were asked if there was a time they called for assistance and staff did not respond or come, four (4) out of eleven (11) stated there has been a time when they called for assistance and staff did not come to assist. Additionally, Residents R1, R3, R4, and R6, were asked what time of day the incident occurred, four (4) out of four (4) stated it happened during the evening and nights.

Allegation: Staff do not ensure facility is free from pests.

The complaint allegation alleges roaches were observed in the dining room and residents’ bed has bed bugs.
During the facility inspection, the Department did not observe insects or any traces of insects. The facility and rooms inspected were observed clean and sanitary.

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Wendy Gibbs	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 10/23/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/23/2024

LIC9099 (FAS) - (06/04)

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Control Number 11-AS-20241015140936

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: 10/23/2024

NARRATIVE

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During Record review, the Department received and reviewed receipts from Terminix pest control company dated 07/03/24 through 09/25/24. The Department observed Terminix has come out weekly to provide services.
During interviews with Staff S1-S8, were asked if they have recently observed any insects or pests inside the facility, six (6) out of eight (8) stated they have not seen any insects inside the facility. Two (2) out of eight (8) stated they see cockroaches off and on but not since June. Additionally, Staff were asked if there is a pest control company that comes and provides services, eight (8) out of eight (8) stated Terminix comes out on a weekly basis to provide services.

During interviews with Residents R1- R11, were asked if they have recently observed any insects or pests inside the facility, five (5) out of eleven (11) stated they have observed cockroaches inside the facility. Additionally, they stated if they see them inside the facility is on it and takes care of it quickly. Additionally, Residents R1-R11, were asked if there is a company that comes out to treat for the cockroaches, eleven (11) out of eleven (11), stated there is a company that comes out regularly.

Allegation: Staff do not maintain facility in good repair.

The complaint allegation alleges that their air conditioning and refrigerator in their room is not working properly.
During the facility inspection, the Department observed the facility to be in good repair. The Department checked residents air conditioning and refrigerator in rooms visited and observed them to be working.
During record review, the Department received and reviewed work orders from 09/14/24 through 10/23/24.

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Wendy Gibbs	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 10/23/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/23/2024

LIC9099 (FAS) - (06/04)

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Control Number 11-AS-20241015140936

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: 10/23/2024

NARRATIVE

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During interviews with Staff S1 – S8, were asked what the process and procedure is if a resident reports something not working in their room is, eight (8) out of eight (8) stated once an issue is reported a work order is created, maintenance goes right away to check on the issue and they decide what is needed for a repair and once parts are ordered and received the issue is fixed. If the issue can be fixed right away, they fix it then.
During interviews with Residents R1- R11, were asked if there was anything in the facility or in their room that is not working properly, ten (10) out of eleven (eleven) stated everything in their room is working properly and if something needs fixed, they come right away to fix it. During an interview with R1, they stated their refrigerator keeps freezing up and needs defrosted then sometimes takes a while to get cold. During the facility inspection, the Department observed R1’s refrigerator was working properly.

During the course of the investigation, LPA was unable to find evidence to support the allegations. Although the allegations may have happened or is valid, there is no preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated.

An exit interview was conducted with Executive Director, Suzette Johnson, and a copy of this report was provided.

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Wendy Gibbs	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 10/23/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/23/2024

LIC9099 (FAS) - (06/04)

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