197608044-6-2-2021-11-AS-JHAD-C3MUVV-20210603155545

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608044
Report Date: 05/24/2021
Date Signed: 06/02/2021 04:50:58 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
04/28/2021 and conducted by Evaluator Ulysses Coronel

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20210428110740

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: 115	DATE:	05/24/2021
		UNANNOUNCED	TIME BEGAN:	10:13 AM
MET WITH:	Nishith Modi		TIME COMPLETED:	11:14 AM

ALLEGATION(S):

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Staff uses profanity in the presence of the residents.
Staff withheld residents' checks.

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 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 “Staff uses profanity in the presence of the residents.” On 05/03/2021 10 out of 10 residents interviewed denied witnessing staff using profanity on other staff.”, resident R8 stated “No, everybody gets along well here” S1 stated "No, usually the managers call staff one by one, upstairs by themselves." Regarding the allegation, “Staff uses profanity in the presence of the residents.” 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.

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-20210428110740

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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Regarding the allegation: “Staff withheld residents' checks.” On 05/03/2021 10 out of 10 residents interviewed denied having their stimulus check are being withheld, resident R6 stated "No, I got mine already." R10 stated ”No, I didn't ask for all of it all.” Administrator stated "Residents can come to the business office and ask for cash money from here anytime. Like for example the stimulus check they can come here and ask for whatever amount and we will give it to them." Regarding the allegation: “Staff withheld residents' checks” 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.

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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