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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197608029
Report Date: 07/15/2025
Date Signed: 07/15/2025 03:32:03 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
07/08/2025 and conducted by Evaluator Lizeth Villegas
COMPLAINT CONTROL NUMBER: 11-AS-20250708103808
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: 250DATE:
07/15/2025
UNANNOUNCEDTIME BEGAN:
09:46 AM
MET WITH:Executive Director Suzette JohnsonTIME COMPLETED:
03:45 PM
ALLEGATION(S):
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Staff are not safeguarding resident's belongings.
INVESTIGATION FINDINGS:
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On 07/15/25 Licensing Program Analyst (LPA) Villegas conducted an initial complaint visit regarding the allegation(s) above. LPA met with (S1) Executive Director Suzette Johnson as the purpose of today’s visit was explained.

The investigation consisted of the following: On 07/15/25 LPA Villegas obtained copies of the staff and resident roster, surety bond and requested the following documents for resident #1 (R1); emergency ID form, admission agreement dated: , physicians report dated: 12/24/24 preplacement appraisal dated:9/10/24, service plan dated:9/13/24, resident personal property and valuables dated 9/11/24, resident theft and loss record, P&I account log from October 2024-July 2025. On 07/15/25 from 10:15 am- 12:18 pm LPA conducted Interviews with Residents#00-10 (R0-R10), and between 1:00pm- 2pm LPA conducted interviews with staff # 1-00 (S1-00). On 07/15/25 LPA conducted a review of R1's file.

The investigation revealed the following:

Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Lizeth Villegas
LICENSING EVALUATOR SIGNATURE:

DATE: 07/15/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/15/2025
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-20250708103808
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: 07/15/2025
NARRATIVE
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Allegation: Staff are not safeguarding resident's belongings.
It is being alleged that someone is stealing money from a resident in care. On 07/15/25 from 10:15 am- 12:18 pm LPA conducted Interviews with R1-R10 regarding the allegation above, 9 of 10 residents interviewed denied the allegation above and stated their money have not been stolen or misplaced at the facility. 1 of 10 residents interviewed confirmed the allegation above, per resident money has gone missing twice, however it was not reported to staff. On 07/15/25 from 1:00pm- 2pm LPA conducted interviews with S1-S6 regarding the allegation above, 6 of 6 staff denied the allegation above. 6 of 6 staff interviewed reported that if a resident reports having their property stolen, staff will document it on the communication log, and report it to management for investigation. On 07/15/25 at 2:30 pm LPA spoke to W1 regarding the allegation above, W1 has no concerns regarding the allegation above. On 07/15/25 LPA conducted a review of R1's file, per physicians report dated: 12/24/24, R1 cannot handle own cash resources, R1 has a financial power of attorney. On 07/15/25 LPA reviewed the Resident theft and loss record, LPA did not observe R1 to be listed as reporting any loss or theft. On 07/15/25 LPA reviewed P&I account log from October 2024-July 2025, per log R1 has been receiving funds weekly.

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, and a copy of this report was provided.
SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Lizeth Villegas
LICENSING EVALUATOR SIGNATURE:

DATE: 07/15/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/15/2025
LIC9099 (FAS) - (06/04)
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