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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197608029
Report Date: 07/02/2025
Date Signed: 07/16/2025 04:58:45 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
06/25/2025 and conducted by Evaluator Jose Anguiano
PUBLIC
COMPLAINT CONTROL NUMBER: 11-AS-20250625084748
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: 252DATE:
07/02/2025
UNANNOUNCEDTIME BEGAN:
08:11 AM
MET WITH:Suzette JohnsonTIME COMPLETED:
12:00 PM
ALLEGATION(S):
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Staff did not keep the facility free of rodents
INVESTIGATION FINDINGS:
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On 07/02/2025 at 8:11 AM, Licensing Program Analyst (LPA) Jose Anguiano conducted an initial visit to gather information regarding the above allegation. LPA met with the Resident Care Director Sidonia Cordis, and the purpose of the visit was explained. LPA was granted entry to the facility.

Investigation consisted of the following:
On 07/02/2025 at approximately 8:40 AM, LPA Anguiano conducted a physical plant inspection of the kitchen, and dining room. During the kitchen inspection, rodent droppings were observed on multiple areas, including:
• On the floor beneath the prep tables
• Behind the refrigerators
• Underneath the water container storage area

Please see LIC9099-C for additional documentation.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Jose Anguiano
LICENSING EVALUATOR SIGNATURE:

DATE: 07/02/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/02/2025
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-20250625084748
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: 07/02/2025
NARRATIVE
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No live rodents were observed at the time of the visit. Per interview with (S2), who has been employed at the facility for approximately one month, kitchen cleaning is performed regularly; however, no formal cleaning logs or documentation are maintained.
Photographs of the observed droppings were taken by LPA.

LPA Jose Anguiano also reviewed a Dewey Pest Control Service Agreement, which provided valid proof of an annual service contract. This contract indicated that the services are performed monthly on Wednesday’s. Additionally, a review of the Dewey Pest Control Service Log, covering the period from March 1, 2025, and April 29, 2025, confirmed that treatment services are being performed monthly.

During this investigation, LPA did not find sufficient evidence to support the above-mentioned allegation.
Based on the evidence gathered, interviews conducted, and records reviewed, the preponderance of evidence standard has been met; therefore, the above-mentioned allegation 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, therefore the allegations are unsubstantiated.

An exit interview was conducted, and a copy of the Complaint Report was given to Suzette Johnson.
SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Jose Anguiano
LICENSING EVALUATOR SIGNATURE:

DATE: 07/02/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/02/2025
LIC9099 (FAS) - (06/04)
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