197608029-12-26-2024-11-AS-EMAZ-DCZUAY-20250117142531

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608029
Report Date: 12/26/2024
Date Signed: 12/26/2024 04:41:29 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
12/19/2024 and conducted by Evaluator Alfonso Iniguez

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20241219092922

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:	12/26/2024
		UNANNOUNCED	TIME BEGAN:	08:21 AM
MET WITH:	Suzette S. Johnson-Executive Director		TIME COMPLETED:	04:30 PM

ALLEGATION(S):

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Staff do not assist resident with obtaining medical care.
Staff do not allow resident to choose care provider.
Staff did not safeguard resident's personal belongings.

INVESTIGATION FINDINGS:

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On 12/26/2024 LPA Alfonso Iniguez conducted an unannounced complaint visit. LPA Iniguez met with Suzette S. Johnson/ Executive Director. LPA Iniguez explained the purpose of this visit.

Investigation Consisted of: LPA conducted the following interviews: Administrator Interview(A#1), Staff Interviews (S#1-S#9) and Resident’s interviews (R#1-R#14). LPA obtained and reviewed the following documents: Resident’s roster, Personnel roster, (R#1-R#4) Identification and Emergency Information, (R#1-R#4) Admissions agreements, (R#1-R#4) Physicians Report or LIC 602A, (R#1-R#4) Client/Resident Personal Property and Valuables or LIC 621, (R#1)’s Doctor’s letter dated 12/9/24.

Evaluation Report continues LIC 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Alfonso Iniguez	TELEPHONE: 323-981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 12/26/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/26/2024

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 5

Control Number 11-AS-20241219092922

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: 12/26/2024

NARRATIVE

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Investigation Revealed the Following:

Allegation: Allegations: Staff do not assist resident with obtaining medical care.

The details of the complaint alleged that facility staff is not assisting (R#1) with their medical appointments.

During the records review, LPA Iniguez reviewed (R#1)’s medical file; LPA observed that (R#1) has Kaiser as their medical provider. A letter dated 12/9/24 from (R#1)’s doctor states that (R#1) requested to manage their own medications and medical care; the doctor wrote that they could manage their medications and medical care.

During an Interview with the Administrator (A#1), she stated that in the case of (R#1), they call Kaiser to have them pick them up, but we can always provide transportation for them if they need it.

During interviews with residents (R#1-R#14), (8) out of (14) stated that the family takes them to their medical appointments, (1) out of (14) stated that they go on their own, (5) out of (14) state that the used the facility transportation and (1) out of (14) stated that their doctor comes at the facility to see them. In addition, (13) out of (14) residents stated that they feel the facility will assist them if they require transportation to their medical appointments.

During interviews with facility staff (S#1-S#9), (9) out (9) stated that the facility provides and assists the residents in care with transportation.

Evaluation Report continues LIC 9099-C

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Alfonso Iniguez	TELEPHONE: 323-981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 12/26/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/26/2024

LIC9099 (FAS) - (06/04)

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Control Number 11-AS-20241219092922

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: 12/26/2024

NARRATIVE

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Allegation: Staff do not allow resident to choose care provider.

The details of the complaint alleged that facility administrator is forcing (R#1) to choose in-house doctor.

During the records review, LPA Iniguez examined (R#1)’s medical file and noted that (R#1) is enrolled with Kaiser as their medical provider. A letter dated December 9, 2024, from (R#1)’s doctor confirms that (R#1) requested to manage their own medications and medical care and has an active membership on file.

During an interview with the administrator (A#1), she stated that she had never forced (R#1) or other residents in care to change their primary care physicians to choose our in-house doctor.

During interviews with residents (R#1-R#14), (13) out of (14) stated that the administrator has never forced them to change their primary care physician for an in-house doctor.

During interviews with facility staff (S#1-S#9), (9) out (9) stated that they had never heard that the administrator was forcing the residents in care to change their doctors for the facility doctor.

Evaluation Report continues LIC 9099-C

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Alfonso Iniguez	TELEPHONE: 323-981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 12/26/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/26/2024

LIC9099 (FAS) - (06/04)

Page: 3 of 5

Control Number 11-AS-20241219092922

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: 12/26/2024

NARRATIVE

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Allegation: Staff did not safeguard resident's personal belongings.

The details of the complaint alleged that facility staff is not safeguarding (R#1)’s personal belongings.

During the records review, LPA Iniguez reviewed (R#1)’s admission file. LPA observed that (R#1) declined to list their personal belongings on the Client/Resident Personal Property and Valuables or LIC 621 form, which is dated 3/14/2024 and signed by (R#1). In addition, LPA reviewed (R#2-R#4)’s admission files, and everyone has an LIC 621 form on file.

During an Interview with the Administrator (A#1), she stated that the facility staff safeguard the personal belongings of (R#1) and the residents in care. The facility staff never takes anything from the resident’s room, including money. In addition, (A#1) stated that she had never heard about a resident sleeping in their wheelchair the whole night because their bed was broken.

During interviews with residents (R#1-R#14), (13) out of (14) stated that they have an inventory list on file and that the facility staff is not taking their personal belongings, including money. In addition, (13) out of (14) residents stated that they had never heard of another resident sleeping in their wheelchair the whole night because their bed was broken.

During interviews with staff (S#1-S#9), (9) out (9) stated that they do not take the personal belongings of (R#1) or other residents in care, including money. In addition, (9) out of (9) facility staff never heard about a resident sleeping in their wheelchair the whole night because their bed was broken.

Evaluation Report continues LIC 9099-C

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Alfonso Iniguez	TELEPHONE: 323-981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 12/26/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/26/2024

LIC9099 (FAS) - (06/04)

Page: 4 of 5

Control Number 11-AS-20241219092922

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: 12/26/2024

NARRATIVE

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During this investigation, LPA found did not find sufficient evident to support the above-mentioned allegation(s).

Based on the evidence gathered, interviews conducted, and records reviewed, the preponderance of evidence standard has been met; therefore, the above-mentioned allegation(s) are found to be UNSUBSTANTIATED.

Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur.

An exit interview was conducted, and a copy of the Complaint Report was given to Suzette S. Johnson / Executive Director.

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Alfonso Iniguez	TELEPHONE: 323-981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 12/26/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/26/2024

LIC9099 (FAS) - (06/04)

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