197608029-8-12-2025-11-AS-JHAD-DKT2GJ-20250822172313

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608029
Report Date: 08/12/2025
Date Signed: 08/12/2025 03:17:27 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
08/07/2025 and conducted by Evaluator Lizeth Villegas

COMPLAINT CONTROL NUMBER: 11-AS-20250807142442

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: 250	DATE:	08/12/2025
		UNANNOUNCED	TIME BEGAN:	10:45 AM
MET WITH:	Executive Director Suzette Johnson		TIME COMPLETED:	03:37 PM

ALLEGATION(S):

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Staff are not properly addressing pest infestation in the facility.

INVESTIGATION FINDINGS:

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On 08/12/25 at 10:45 am Licensing Program Analyst (LPA) Villegas conducted a subsequent complaint visit regarding the allegation(s) above. LPA met with Executive Director Suzette Johnson, as the purpose of today’s visit was explained.

The investigation consisted of the following: On 08/12/25 LPA Villegas obtained copies of the staff and resident roster, and copies of the following documents for resident #1 (R1) face sheet, service plan dated: 06/21/25, Physicians report dated: 05/25/25, medication administration record (MAR) for 08/2025, communication notes, housekeeping schedule, deep cleaning schedule, Dewey pest control agreement, Dewey service logs dated June 2025-August 2025. On 08/12/25 from 12pm-1:25pm LPA conducted Interviews residents #2-10 (R2-R10), and from 1:35pm- 2:32pm LPA conducted interviews with staff #1-5 (S1-S5). On 08/12/15 LPA unable to interview R1 as R1 refused interview. On 08/12/25 LPA conducted tour of the facility and conduct check of 5 bedrooms.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Lizeth Villegas
LICENSING EVALUATOR SIGNATURE:	DATE: 08/12/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/12/2025

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-20250807142442

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: 08/12/2025

NARRATIVE

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The investigation revealed the following:

Allegation: Staff are not properly addressing pest infestation in the facility.
It is being alleged that a resident in care has bugs crawling on body and face throughout the night. On 08/12/25 from 12pm-1:25pm LPA conducted Interviews with R2-R10 regarding the allegation above, 3 of 9 residents interviewed reported observing pest in the bedrooms, and reported having their bedrooms treated after staff was made aware. 6 of 9 residents interviewed denied the allegation above and reported their bedrooms have been treated for pest as a precaution. On 08/12/15 LPA unable to interview R1 as R1 refused interview. On 08/12/25 from 1:35pm- 2:32pm LPA conducted interviews with S1-S5 regarding the allegation above, 5 of 5 staff interviewed denied the allegation above, and reported that R1 does not allow staff to come into R1's bedroom to provide cleaning services. Additionally 5 of 5 staff interviewed stated that R1 threatens to call law enforcement and a Lawyer if staff attempt to enter R1's bedroom. On 08/12/25 LPA conducted a review of Dewey pest control services logs, per service log R1's bedroom was services on 6/20/25. LPA conducted a review of Dewey pest control service agreement, per agreement 10 bedrooms are treated weekly as well as common areas, and the building exterior. On 08/12/25 LPA conducted a review of communication notes, LPA observed documented communication from staff reported that R1 does not allow entry into R1's bedroom.

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: 08/12/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/12/2025

LIC9099 (FAS) - (06/04)

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