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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197608044
Report Date: 02/15/2022
Date Signed: 02/16/2022 08:17:15 AM



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
02/07/2022 and conducted by Evaluator Ulysses Coronel
COMPLAINT CONTROL NUMBER: 11-AS-20220207095943
FACILITY NAME:VISTA VERANDA ASSISTED LIVINGFACILITY NUMBER:
197608044
ADMINISTRATOR:NISHITH MODIFACILITY TYPE:
740
ADDRESS:3540 MARTIN LUTHER KING, JR.TELEPHONE:
(310) 638-4113
CITY:LYNWOODSTATE: CAZIP CODE:
90262
CAPACITY:178CENSUS: 98DATE:
02/15/2022
UNANNOUNCEDTIME BEGAN:
09:28 AM
MET WITH:NIshith ModiTIME COMPLETED:
05:40 PM
ALLEGATION(S):
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The administration did not give residents notice of a rent increase.
INVESTIGATION FINDINGS:
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 Licensing Program Analyst (LPA) Ulysses Coronel and LPA Jeremiah Randle conducted an initial 10-Day Complaint Investigation visit and met with Nishith Modi, the administrator and the purpose of the visit was explained.

The investigation consisted of the following:On 02/15/2022 LPAs and administrator conducted a tour of the facility, LPAs interviewed the administrator, 4 staff and 8 out of 73 residents. LPAs also reviewed and obtained copies of residents admission agreements, ledgers and rent inrease notices.

The investigation revealed the following: Regarding the allegation: "The administration did not give residents notice of a rent increase." It is alleged that the administration failed to provide residents notices of rent inrcrease 60 days prior to said increase. During record reviews LPA Coronel reviewed a copy of a letter dated 12/27/2021 notifying residents of the rent increase effective 01/01/2022. Administrator also provided a copy of PIN 21-23-CCLD dated 11/19/2021 regarding SSI/SSP Payment Stardards effective 01/01/2022.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Janae HammondTELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Ulysses CoronelTELEPHONE: (951) 212-8917
LICENSING EVALUATOR SIGNATURE:

DATE: 02/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/15/2022
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 5
Control Number 11-AS-20220207095943
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: 02/15/2022
NARRATIVE
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 During interviews 8 out of 8 residents interviewed stated that notices dated 12/27/2021 regarding rent increase for January 2022 were provided to them on January of 2022. Regarding the allegation: "The administration did not give residents notice of a rent increase. Based on interviews which were conducted and the records that were reviewed, the preponderance of evidence standard has been met, therefore the above allegation is found to be substantiated. California Code of Regulations, Title 22, Division 6 and Chapter 8 are being cited on the attached LIC9099D.


An exit interview was conducted and plans of correction developed. A copy of this report and appeals rights were provided to Nishith Modi.
SUPERVISOR'S NAME: Janae HammondTELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Ulysses CoronelTELEPHONE: (951) 212-8917
LICENSING EVALUATOR SIGNATURE:

DATE: 02/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/15/2022
LIC9099 (FAS) - (06/04)
Page: 4 of 5
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
02/07/2022 and conducted by Evaluator Ulysses Coronel
COMPLAINT CONTROL NUMBER: 11-AS-20220207095943

FACILITY NAME:VISTA VERANDA ASSISTED LIVINGFACILITY NUMBER:
197608044
ADMINISTRATOR:NISHITH MODIFACILITY TYPE:
740
ADDRESS:3540 MARTIN LUTHER KING, JR.TELEPHONE:
(310) 638-4113
CITY:LYNWOODSTATE: CAZIP CODE:
90262
CAPACITY:178CENSUS: 98DATE:
02/15/2022
UNANNOUNCEDTIME BEGAN:
09:28 AM
MET WITH:NIshith ModiTIME COMPLETED:
05:40 PM
ALLEGATION(S):
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Staff withheld resident's mail.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Ulysses Coronel and LPA Jeremiah Randle conducted an initial 10-Day Complaint Investigation visit and met with Nishith Modi, the administrator and the purpose of the visit was explained.

The investigation consisted of the following: On 02/15/2022 LPAs and administrator conducted a tour of the facility, LPAs interviewed the administrator, 4 staff and 8 out of 73 residents.

Regarding the allegation: "Staff withheld resident's mail." During interviews the administrator stated that he needs to segregate the facility's business mail and former residents mail from the residents mail prior to distribution. 2 out of 4 staff interviewed stated that mail received during the weekends are not distributed until the following weekday. 5 out of 8 residents interviewed did not have concerns about their mail being withheld and 3 out of 8 residents stated their mails were being withheld by the administrator, Resident R1 stated that "I have not been getting my mail"
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Janae HammondTELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Ulysses CoronelTELEPHONE: (951) 212-8917
LICENSING EVALUATOR SIGNATURE:

DATE: 02/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/15/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 11-AS-20220207095943
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: 02/15/2022
NARRATIVE
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Regarding the allegation: "Staff withheld resident's mail." 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.

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

DATE: 02/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/15/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 11-AS-20220207095943
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/15/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/01/2022
Section Cited
CCR
87507(g)(4)
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 87507(g)(4)(A) Admission Agreements. Admission agreements shall specify the following: Modification conditions,... the provision of ... written notice to the resident of any rate or rate structure change, or as soon as the licensee is notified of SSI/SSP rate changes. This requirement was not met as evidenced by:
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The administrator agreed review Title 22 regultion 87507(g)(4)(A) and will crate a plan to ensure that 60 days prior written notice to the resident of any rate or rate structure change, or as soon as the licensee is notified of SSI/SSP rate changes will be provided to residents. Proof of correction will be submitted by POC Due Date:
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 Based on interviews and record reviews, the licensee failed to ensure that written notices were provided as soon as the licensee is notified of rate changes, the administrator did not give residents notice of rate increase when they received notice on 11/19/2021 which poses a potential health and safety risk to residents in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Janae HammondTELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Ulysses CoronelTELEPHONE: (951) 212-8917
LICENSING EVALUATOR SIGNATURE:

DATE: 02/15/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/15/2022
LIC9099 (FAS) - (06/04)
Page: 5 of 5