197608044-2-12-2023-11-AS-TVAO-CP4SUP-20230216131126

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608044
Report Date: 01/19/2023
Date Signed: 02/12/2023 04:28:22 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/11/2023 and conducted by Evaluator Kimberly Ramirez

COMPLAINT CONTROL NUMBER: 11-AS-20230111114742

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: 66	DATE:	01/19/2023
		UNANNOUNCED	TIME BEGAN:	01:15 PM
MET WITH:	Administrator Nishith Modi		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

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Staff did not safeguard resident's personal belongings.

INVESTIGATION FINDINGS:

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This is a corrected verison of previous complaint report dated 01/19/2023. Verbiage was corrected on LIC 9099-C. Licensing Program Analyst (LPA) Kimberly Ramirez conducted an unannouced 10-Day complaint visit to investigate the above allegation. The purpose of the visit was discussed with Administrator Modi.

The investigation consisted of: Tour of interior of facility,tour of laundry room, Memory Care Unit, Staff interviews (S1- S6),and Resident interviews (R1-R8). The following documents were obtained: R1- R8 Face sheet, LIC 500, Resident Personal Property and Valuables and Resident Roster.
The investigation revealed the following regarding staff not safeguarding resident's personal belongings: Three (3) out of eight (8) residents recall some items missing from their room at one time or another but could not recall time or date of incident; the items allegedly missing were of nominal value. Six (6) out of the six staff deny witnessing or taking residents personal belongings. Staff alleges they assist residents when they notify them that they misplaced or are missing items from their room.

See LIC 9099C for report continuation.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Tony Vasallo	TELEPHONE: (323) 313-3425
LICENSING EVALUATOR NAME: Kimberly Ramirez	TELEPHONE: (323) 516-3833
LICENSING EVALUATOR SIGNATURE:	DATE: 01/19/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/27/2023

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-20230111114742

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: VISTA VERANDA ASSISTED LIVING	FACILITY NUMBER: 197608044
	VISIT DATE: 01/19/2023

NARRATIVE

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Allegation: “Staff did not safeguard resident's personal belongings.” Based on record review and interviews conducted, staff denies the allegation and insist they help residents find their items they may have misplaced. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED.

Exit interview held, and a copy of this report was left with Administrator Modi.

SUPERVISOR'S NAME: Tony Vasallo	TELEPHONE: (323) 313-3425
LICENSING EVALUATOR NAME: Kimberly Ramirez	TELEPHONE: (323) 516-3833
LICENSING EVALUATOR SIGNATURE:	DATE: 01/27/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/27/2023

LIC9099 (FAS) - (06/04)

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