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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197608044
Report Date: 10/04/2021
Date Signed: 12/16/2021 04:35:33 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		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 LIVINGFACILITY NUMBER:
197608044
ADMINISTRATOR:YVETTE LEMFACILITY TYPE:
740
ADDRESS:3540 MARTIN LUTHER KING, JR.TELEPHONE:
(310) 638-4113
CITY:LYNWOODSTATE: CAZIP CODE:
90262
CAPACITY:178CENSUS: 83DATE:
10/04/2021
TYPE OF VISIT:OfficeUNANNOUNCEDTIME BEGAN:
03:25 PM
MET WITH:NIshith ModiTIME COMPLETED:
03:56 PM
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On 10/04/2021 Licensing Program Manager (LPM) Janae Hammond and Licensing Program Analyst (LPA) Ulysses Coronel conducted an office meeting with Licensee Representative Kinal Modi and Nishith Modi regarding transitioning of Nishith Modi as the new facility administrator following Yvette Lem leaving as the administrator of the facility. The following were discussed during todays meeting:
  • Kinal Modi is actively looking to hire a new administrator.
  • A new administrator packet will be submitted for Nishith Modi.
  • An updated LIC500 will be submitted to CCLD.
  • Nishith will ensure that all caregiver shifts will be covered and will immediately notify licensing in case of staffing shortage.
  • Kinal Modi is actively looking to hire new caregiver staff and additional business office staff.
  • Nishith Modi will take over with helping the departments Auditors with their requests for information.
  • Incident reports will be submitted in a timely manner and administrator will immediately notify licensing on any immediate concerns regarding urgent matters.
  • The facility will continue to provide daily activities to the residents that are compliant with the DPH guidance.
  • The administration will ensure that they are always up to date with the Provider Information Notices (PINs)
  • Negative test results for 3 unvaccinated staff and proof of vaccinations of vaccinated staff will be documented and available upon request.
  • As the new administrator Nishith Modii will ultimately be responsible for Vista Veranda and will remain in compliance with Title 22 Regulations and should contact licensing for questions or clarifications.
  • LPA Coronel will continue to conduct monthly visits and provide technical assistance as needed.


A copy of this report was provided.
SUPERVISOR'S NAME: Janae HammondTELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Ulysses CoronelTELEPHONE: (951) 212-8917
LICENSING EVALUATOR SIGNATURE:

DATE: 10/04/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/04/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
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