197608029-10-24-2024-11-AS-JHAD-DBLRFG-20241203115907

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608029
Report Date: 10/24/2024
Date Signed: 10/24/2024 03:42:19 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
10/08/2024 and conducted by Evaluator Lizeth Villegas

COMPLAINT CONTROL NUMBER: 11-AS-20241008133500

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:	10/24/2024
		UNANNOUNCED	TIME BEGAN:	08:56 AM
MET WITH:	Executive Director Suzette Johnson		TIME COMPLETED:	02:00 PM

ALLEGATION(S):

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Staff is serving food that is not of good quality.
Foods are not properly labeled.

INVESTIGATION FINDINGS:

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On 10/24/24 at 9:00am, Licensing Program Analyst (LPA) Lizeth Villegas conducted a subsequent complaint visit regarding the allegation above. LPA met with Executive Director (ED) Suzette Johnson as the purpose of today’s visit was explained.

The investigation consisted of the following: On 10/17/24 LPA Villegas conducted an initial complaint visit regarding the allegation above. On 10/17/24 LPA obtained copies of the following: Staff and resident rosters, menus for September- October 2024, alternative menu, and sanitation inspection of kitchen dated 09/21/24, documentation of food temperatures for September-October 2024 as well as copies of pertinent documents for resident #1 (R1). On 10/17/24 from 9:30am-10 am LPA conducted interview with R1, and between 10:00am- 11:30 am LPA conducted interviews with ED and staff #1-5 (S1-S5). LPA toured facility kitchen and observed dining room during lunch seating(s). On 10/24/2024 Between 9:30am- 11:45am LPA conducted interviews with residents #2-10 (R2-R10), and once again observed dining room during lunch seating(s).

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (424) 544-1027
LICENSING EVALUATOR NAME: Lizeth Villegas	TELEPHONE: (818) 391-9974
LICENSING EVALUATOR SIGNATURE:	DATE: 10/24/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/24/2024

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-20241008133500

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: 10/24/2024

NARRATIVE

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The investigation revealed the following: Allegation: Staff is serving food that is not of good quality. It is alleged that facility is not serving food of good quality. On 10/17/24 between 10:00am- 11:30 am LPA conducted interview with ED regarding the allegation above, ED denied the allegation above and reported there are monthly meetings held to hear the needs of the residents. On 10/17/24 between 10:00am- 11:30am LPA conducted interviews with S1-S5 regarding the allegation above, 5 of 5 staff interviewed denied the allegation above and reported residents have not complained of the food quality. On 10/17/2024 LPA toured the inside of the facility, during the tour LPA observed the kitchen, dining area and the facility’s food supply. LPA observed residents eating in the dining area and LPA did not observe food not of good quality being served. On 10/17/24 from 9:30am-10 am LPA conducted interview with R1, and on 10/24/2024 between 9:30am- 11:45am LPA conducted interviews with R2-R10. 8 of 10 residents interviewed denied the allegation above and reported having no concerns regrading the quality of food being served, 2 of 10 resident interviewed stated the food can be better. On 10/24/24 LPA observed residents having lunch in the dining area and did not observe food not of good quality being served.

Allegation: Foods are not properly labeled It is being alleged that drinks served are not labeled sugar or sugar free. On 10/17/24 between 10:00am- 11:30 am LPA conducted interview with ED regarding the allegation above, ED denied the allegation above and reported kitchen manager oversees the labeling in the kitchen. On 10/17/24 between 10:00am- 11:30am LPA conducted interviews with S1-S5 regarding the allegation above, 5 of 5 staff interviewed denied the allegation above. On 10/17/24 LPA conducted a tour of the facility kitchen as well as observed lunch seatings, LPA observed sugar free items to be separated and labeled in the pantry. LPA also observed the juice which was placed in a beverage pitcher to be labeled as regular/sugar and or sugar free. On 10/17/24 from 9:30am-10 am LPA conducted interview with R1, and on 10/24/2024 between 9:30am- 11:45am LPA conducted interviews with R2-R10. 5 of 10 residents interviewed denied the allegation above, 2 of 10 residents interviewed were unsure of labeling, 2 of 10 residents interviewed reported drinks are sometimes labeled, and 1 of 10 residents interviewed confirmed the allegation and reported juices are not labeled when served.

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

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (424) 544-1027
LICENSING EVALUATOR NAME: Lizeth Villegas	TELEPHONE: (818) 391-9974
LICENSING EVALUATOR SIGNATURE:	DATE: 10/24/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/24/2024

LIC9099 (FAS) - (06/04)

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