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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197608029
Report Date: 11/22/2024
Date Signed: 11/22/2024 12:04:59 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
11/20/2024 and conducted by Evaluator Perry Scott
PUBLIC
COMPLAINT CONTROL NUMBER: 11-AS-20241120082650
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: 247DATE:
11/22/2024
UNANNOUNCEDTIME BEGAN:
09:19 AM
MET WITH:Suzette JohnsonTIME COMPLETED:
12:00 PM
ALLEGATION(S):
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Staff do not ensure facility is free from pests.
Staff does not ensure that facility is adequately cleaned.
INVESTIGATION FINDINGS:
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On 11/22/24, at 09:00am, Licensing Program Analyst (LPA) Perry Scott conducted an initial complaint visit to the facility and was greeted by Suzette Johnson, Executive Director. LPA explained the purpose of this visit is to gather information about the complaint, gather facility files, and deliver findings for the allegations mentioned above.

The investigation consisted of the following: The department investigated the allegations mentioned in this complaint; and conducted interviews with staff (S1-S4) and residents (R1-R10). The department received the following: Resident Roster (No Date) Staff Roster (Dated: 11/22/2024), Pest Control Invoice (Dated: 07/31/2024, 08/31/2024, 09/30/2024, & 10/31/2024), and Deep Cleaning Schedule (Dated: 07/24/2022) were obtained from the facility.

The investigation revealed the following: Allegation #1-Staff do not ensure facility is free from pests.

Complaint Report continued on LIC9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Janae HammondTELEPHONE: (424) 544-1027
LICENSING EVALUATOR NAME: Perry ScottTELEPHONE: (707) 849-2315
LICENSING EVALUATOR SIGNATURE:

DATE: 11/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/22/2024
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 2
Control Number 11-AS-20241120082650
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: 11/22/2024
NARRATIVE
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The details of the complaint alleged that the facility has roaches throughout the building and in the Spa Room. On 11/22/24, from 9:30am-12:00pm, the department interviewed staff (S1-S4) and residents (R1-R10) regarding the allegation. 4 of 4 staff denied the allegation that the Staff do not ensure facility is free from pests. All staff (S1-S4) interviewed stated that the facility has a pest control company (Terminix) that comes weekly and sprays, set traps, and tries to prevent any further infestations. During a record review, the department received and reviewed receipts from Terminix Pest Control company dated 07/31/2024, 08/31/2024, 09/30/2024, & 10/31/2024. The Department observed that Terminix has weekly visits to the facility to provide services for any current pests as well as ensure the facility remains pest free by doing preventative services. The department toured the kitchen, Spa Room, bathrooms, dining areas, activity rooms, and resident bedrooms and did not observe any roaches or other pests at the time of the visit.

The department interviewed residents (R1-R10) about the allegation and 8 of 10 residents that were interviewed denied the allegation that Staff do not ensure facility is free from pests. The majority of the residents interviewed (8 of 10) stated that they have not seen any pests in the facility for quite a while. They further state that they believe the facility is doing what it can to keep it free from pests by having pest control come out weekly.

Based on interviews, observation, and records reviewed, there is insufficient evidence to support the allegation that the Staff do not ensure facility is free from pests. 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.

Allegation #2- Staff does not ensure that facility is adequately cleaned.

The details of the complaint alleged that the staff does not ensure that the facility is adequately cleaned. On 11/22/24, from 9:30am-12:00pm, the department interviewed staff (S1-S4) and residents (R1-R10) regarding the allegation. 4 of 4 staff denied the allegation that the Staff does not ensure that facility is adequately cleaned. All staff (S1-S4) interviewed stated that the facility is cleaned daily by maintenance, the janitorial staff, house keepers, and caregivers. S1 stated that the Spa Room, kitchen, bathrooms, dining areas, common rooms, and bedrooms are cleaned daily. Additionally, S1 stated that a deep cleaning of those areas is done weekly. The department toured those areas and observed them to be clean, sanitary, and in compliance with Title 22 regulations.

The department interviewed residents (R1-R10) about the allegation and 9 of 10 residents that were interviewed denied the allegation that Staff does not ensure that facility is adequately cleaned. The majority of the residents (9 of 10) interviewed stated that the staff does ensure the facility is cleaned and sanitary.

Based on interviews, observations, and records reviewed, there is insufficient evidence to support the allegation that the Staff does not ensure that facility is adequately cleaned. 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 deficiencies were cited.

An exit interview was conducted with Suzette Johnson, Executive Director, and a hard copy of this Complaint Investigation Report was provided.

SUPERVISOR'S NAME: Janae HammondTELEPHONE: (424) 544-1027
LICENSING EVALUATOR NAME: Perry ScottTELEPHONE: (707) 849-2315
LICENSING EVALUATOR SIGNATURE:

DATE: 11/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/22/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2