197608044-6-2-2021-11-AS-MVAO-C3NMKV-20210604094123

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608044
Report Date: 05/24/2021
Date Signed: 06/02/2021 02:24:00 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/19/2021 and conducted by Evaluator Ulysses Coronel

COMPLAINT CONTROL NUMBER: 11-AS-20210319103024

FACILITY NAME:	VISTA VERANDA ASSISTED LIVING		FACILITY NUMBER:	197608044
ADMINISTRATOR:	NISHITH MODI		FACILITY TYPE:	740
ADDRESS:	3540 MARTIN LUTHER KING, JR.		TELEPHONE:	(310) 638-4113
CITY:	LYNWOOD	STATE: CA	ZIP CODE:	90262
CAPACITY:	178	CENSUS: 95	DATE:	05/24/2021
		UNANNOUNCED	TIME BEGAN:	10:12 AM
MET WITH:	NIshith Modi		TIME COMPLETED:	10:13 AM

ALLEGATION(S):

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Resident's mail is being opened by somebody other than the resident.
Facility did not provide a meal to resident on more than one occasion.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Ulysses Coronel initiated a complaint investigation for the allegations listed above. Today’s complaint investigation was conducted with Nishith Modi the administrator.

The investigation consisted of the following: On 03/19/2021 LPA Coronel interviewed the administrator and 2 staff, conducted a virtual tour of the facility and requested facility and client records. On 05/03/2021 LPA Coronel conducted virtual tour of the facility and telephonic interviews with the administrator, 9 staff, and 10 out of 106 residents. On 05/19/2021 LPA conducted records reviews.

The investigation revealed the following: Regarding the allegation “Resident's mail is being opened by somebody other than the resident.” On 05/03/2021 10 out of 10 residents interviewed denied having issues receiving their mails, R10 stated “No, I never had issues with mail.”

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Ulysses Coronel	TELEPHONE: (951) 212-8917
LICENSING EVALUATOR SIGNATURE:	DATE: 05/24/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/24/2021

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-20210319103024

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: VISTA VERANDA ASSISTED LIVING	FACILITY NUMBER: 197608044
	VISIT DATE: 05/24/2021

NARRATIVE

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Staff S7 stated "No, staff would hand the mails directly to the residents and if they are not in their rooms staff would try and locate them to give them the mail." Regarding the allegation, “Resident's mail is being opened by somebody other than the resident.” Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated.

Regarding the allegation: “Facility did not provide a meal to resident on more than one occasion.” On 05/03/2021 10 out of 10 residents interviewed denied not being provided meals, resident R4 stated "No, when I am not here during lunch, but when I am back they will give me food when I ask for it.". Staff S9 stated "No, if they are outside on an appointment, the resident would write down on a paper that they are out and when they comeback I will give them their hot meals." Regarding the allegation: “Facility did not provide a meal to resident on more than one occasion.” 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.

An exit interview was conducted and hard copy was provided to administrator Nishith Modi.

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Ulysses Coronel	TELEPHONE: (951) 212-8917
LICENSING EVALUATOR SIGNATURE:	DATE: 05/24/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/24/2021

LIC9099 (FAS) - (06/04)

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