197608029-5-30-2025-11-AS-SCIS-DK5UKX-20250801153954

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608029
Report Date: 05/30/2025
Date Signed: 05/30/2025 10:12:54 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, 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
04/30/2025 and conducted by Evaluator Troy Watson

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20250430092910

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: 247	DATE:	05/30/2025
		UNANNOUNCED	TIME BEGAN:	08:36 AM
MET WITH:	SUZETTE JOHNSON - ADMINISTRATOR		TIME COMPLETED:	10:15 AM

ALLEGATION(S):

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Staff did not ensure resident's catheter care was properly managed.

INVESTIGATION FINDINGS:

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* This report supersedes the report dated 05/14/2025. It does not supersede the findings but is being used to clarify the findings.

On 05/30/2025 Licensing Program Analyst (LPA) Troy Watson made a subsequent unannounced complaint visit to the above listed facility. LPA Watson was greeted by the Administrator Suzette Johnson and explained the purpose of this visit is to deliver findings for the allegation mentioned above.

CONTINUED ON LIC9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Troy Watson
LICENSING EVALUATOR SIGNATURE:	DATE: 05/30/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/30/2025

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-20250430092910

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: 05/30/2025

NARRATIVE

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The investigation consisted of the following:

LPA Watson conducted interviews with residents and staff. LPA Watson requested and received the following: Staff and Resident Roster, SIR reports, Physician's report.A tour of the facility was conducted with the Administrator Suzette Johnson on 05/13/2025.

The investigation revealed the following:
Allegation: Staff did not ensure resident's catheter care was properly managed.
It is being alleged that staff did not ensure that resident’s catheter was regularly emptied and cleaned. On 05/08/2025 the department conducted interviews with Residents #2 - Residents #11 (R2-R11). An attempt to interview Resident #1 (R1) was made but they were no longer at the facility and did not respond to several calls and messages left on their phone/voice mail. The department asked the residents if staff catheters were properly emptied, cleaned and managed? Of those interviewed, 10 out of 10 residents denied the above allegation. On 05/08/2025 the department interviewed Staff #1- Staff #11 (S1-S11). The department asked the staff if catheters were properly emptied, cleaned and managed? Of those interviewed, 11out of 11staff denied the above allegation.

Based on interviews and observations there is insufficient evidence to support the allegation: Staff did not ensure resident’s catheter care was properly managed. 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.

An exit interview was conducted with the Administrator Suzette Johnson and a copy of this report was provided.

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Troy Watson
LICENSING EVALUATOR SIGNATURE:	DATE: 05/30/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/30/2025

LIC9099 (FAS) - (06/04)

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