197608029-11-22-2024-11-AS-JHAD-DDDN4U-20250129090827

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608029
Report Date: 11/22/2024
Date Signed: 11/22/2024 02:34:41 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
11/15/2024 and conducted by Evaluator Lizeth Villegas

COMPLAINT CONTROL NUMBER: 11-AS-20241115123831

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: 246	DATE:	11/22/2024
		UNANNOUNCED	TIME BEGAN:	08:48 AM
MET WITH:	Executive Director Suzette Johnson		TIME COMPLETED:	02:00 PM

ALLEGATION(S):

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Staff do not ensure the facility is free from pests.
Staff do not ensure the facility is clean and sanitary.
Staff do not ensure resident has hot water.

INVESTIGATION FINDINGS:

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On 11/22/24 Licensing program analyst (LPA) Villegas conducted a subsequent complaint visit to deliver findings. LPA met with Executive Director Suzette Johnson as the purpose of today’s visit was explained.

The investigation consisted of the following: On 11/20/24 between 9:30am-11:30am LPA conducted interviews with residents #1-7 (R1-R7), and between 11:30am-12:15pm LPA conducted interviews with staff #1-4 (S1-S4). On 11/20/24 LPA conducted a tour of the inside and outside of the facility and conducted water temperature checks in (4) bedrooms. On 11/20/24 LPA obtained copies of the following documents: staff and resident rosters, Terminex invoices for the months of September and October 2024, deep cleaning schedule, housekeeping schedule for the months of August-November 2024, and the water temperature log for the months of January 2024 -November 2024. On 11/20/24 LPA obtain copies of documents pertinent to the complaint for R1. On 11/22/24 LPA conducted interviews between 9am-11:30am with staff #5 (S5), and residents #8-10 (R8-R10).

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: 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 3

Control Number 11-AS-20241115123831

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 investigation revealed the following:

Allegation: Staff do not ensure the facility is free from pests
It is being alleged that there is a mice, rats, and roach problem at the facility. On 11/20/24 between 11:30 am-12:15pm LPA conducted interviews with S1-S4, 4 of 4 staff interviewed denied the allegation above and reported bedrooms are sprayed by Terminex pest control when pest are reported by residents. 4 of 4 staff also reported rooms are being monitored for pest when cleaning is being conducted. On 11/20/24 between 9:30 am-11:30am LPA conducted interviews with residents R1-R7, 3 of 7 residents interviewed denied the allegation above, 1 of 7 residents refused interview, 3 of 7 residents interviewed confirmed the allegation and reported traps are placed and the bedroom gets sprayed when reported. On 11/22/24 at 9am LPA conducted interview with (S5),1 of 5 staff interviewed denied the allegation above and reported pest control visits the facility regularly to spray. On 11/22/24 between 9:15am- 11:30am LPA conducted interviews with R8-R10 regarding the allegation above, 3 of 3 residents interviewed denied the allegation above. On 11/20/24 while touring the inside and outside of the facility, LPA did not observed any pest activity. On 11/22/24 LPA conducted a a review of Terminex service reports and observed that the facility is being treated weekly.

Allegation: Staff do not ensure the facility is clean and sanitary.
It is being alleged that the facility is dirty and that the staff don't clean the rooms nor the bathrooms well. On 11/20/24 between 11:30 am-12:15pm LPA conducted interviews with S1-S4, 4 of 4 staff interviewed denied the allegation above and reported bedrooms along with the rest of the facility are cleaned daily and bedrooms are deep cleaned 1 time per week. Per 4 of 4 staff, some bedrooms require cleaning 2-3 times a week. On 11/20/24 between 9:30 am-11:30am LPA conducted interviews with residents R1-R7, 5 of 7 residents interviewed denied the allegation above, 1 of 7 residents refused interview, and 1 of 7 residents interviewed confirmed the allegation above, and stated the bedroom is cleaned once a week. On 11/22/24 at 9am LPA conducted interview with (S5),1 of 5 staff interviewed denied the allegation above and reported bedrooms and all common areas are cleaned daily and bedrooms are deep cleaned 1 time per week. On 11/22/24 between 9:15am- 11:30am LPA conducted interviews with R8-R10 regarding the allegation above, 3 of 3 residents interviewed denied the allegation above. On 11/21/24 while conducting tour of the facility LPA observed both floors being cleaned by the staff; trash was being removed and housekeepers were moping the floors. On 11/22/24 LPA reviewed the housekeeping schedule and observed that rooms are cleaned daily and deep cleaned once a week.

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (424) 544-1027
LICENSING EVALUATOR NAME: Lizeth Villegas	TELEPHONE: (818) 391-9974
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 3

Control Number 11-AS-20241115123831

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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Allegation: Staff do not ensure resident has hot water

It is being alleged that R1's bathroom sink has no hot water and get's lukewarm at best.
On 11/20/24 between 11:30am-12:15pm LPA conducted interviews with S1-S4, 4 of 4 staff interviewed denied the allegation above. 1 of 4 staff interviewed stated residents have asked for the water temperature to be higher however it was explained that the facility has to be incompliance with water temperatures and hotter water temperatures may be harmful to other residents. On 11/20/24 between 9:30am-11:30am LPA conducted interviews with residents R1-R7, 5 of 7 residents denied the allegation above, 1 of 7 residents refused the interview, 1 of 7 residents confirmed the allegation and reported the water temperature was turned down, the water temperature is too low and not to the residents liking. On 11/20/24 LPA checked the water temperatures of 4 random rooms and the following was observed: room # 135 water temp 111.7 F, room # 137 water temp 113.6F, room # 293 water temp is 114.2 and room 227 water temp is 116.2. On 11/22/24 at 9am LPA conducted interview with S5, 1 of 5 staff interviewed denied the allegation above. On 11/22/24 between 9:15am- 11:30am LPA conducted interviews with R8-R10 regarding the allegation above, 3 of 3 residents interviewed denied the allegation above. On 11/22/24 LPA conducted review of the water temperature log for the months of January 2024 -November 2024, LPA observed that water temperatures are checked regularly to ensure compliance.

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: 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)

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