197608044-12-7-2023-11-AS-UCOL-CZSRFV-20240124115948

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608044
Report Date: 12/07/2023
Date Signed: 12/07/2023 04:34:08 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO, 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
11/28/2023 and conducted by Evaluator David Espana

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20231128143936

FACILITY NAME:	VISTA VERANDA ASSISTED LIVING		FACILITY NUMBER:	197608044
ADMINISTRATOR:	JESSE LOERA-MOTA		FACILITY TYPE:	740
ADDRESS:	3540 MARTIN LUTHER KING, JR.		TELEPHONE:	(310) 638-4113
CITY:	LYNWOOD	STATE: CA	ZIP CODE:	90262
CAPACITY:	178	CENSUS: 54	DATE:	12/07/2023
		UNANNOUNCED	TIME BEGAN:	08:30 AM
MET WITH:	Jesse Loera-Mota, Administrator		TIME COMPLETED:	05:00 PM

ALLEGATION(S):

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Staff did not ensure the facility is kept at a comfortable temperature for residents in care
Staff did not ensure resident's bathroom is in proper operation

INVESTIGATION FINDINGS:

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On 12/07/2023 at 8:12 am Licensing Program Analyst (LPA) David España conducted an initiated a 10-day complaint investigation follow-up visit for the allegation listed above. Upon arriving at the facility, LPA met with S#1 who assisted with the visit. The purpose of today’s visit was discussed. Upon arrival at the facility, LPA conducted a risk assessment at the front door. Based on the assessment, the facility is clear of Covid-19 infection. LPA was granted access and allowed to enter the facility to conduct inspections.

The investigation consisted of the following: On 12/07/2023 at 8:12 am LPA España conducted a tour of facility plant S#1 and S#2. LPA confirmed that there are currently Fifty-Four (54) residents in care as of 12/07/2023. LPA confirmed that there is Five (5) out of Forty-Six (46) Staff at the time of visit. LPA interview Five (5) of Fourteen (14) staff member at the time of visit. LPA interview Six (6) out of Fifty-Four (54) residents in care.
Continued on 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Ulysses Coronel	TELEPHONE: (323) 400-7397
LICENSING EVALUATOR NAME: David Espana	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 12/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/07/2023

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-20231128143936

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: VISTA VERANDA ASSISTED LIVING	FACILITY NUMBER: 197608044
	VISIT DATE: 12/07/2023

NARRATIVE

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LPA requested records of (1) Generator maintenance (log for the past three months); (2) A/C maintenance (log for the past three months); (3) Gas company maintenance (log for the past three months); (4) Facility maintenance of lighting of both floors (log for the past three months); (5) Records of maintenance of toilets, bathtub, sink, washer, dryer, kitchen, parking lot, facility lights, facility vents, gas, A/C, and other (log for the past three months); (6) Records of maintenance of A/C that has not worked or is not working at the time of this visit (log for the past three months) and (7) a written narrative stating the amount of months A/C has not been working.
Regarding the allegation “Staff did not ensure the facility is kept at a comfortable temperature for residents in care.” It is alleged Resident is not provided a comfortable temperature. The Reporting Party (RP) stated the facility doesn't provide Resident #6 (R6) with air condition during the high temperature or low temperature. Based on the department's interviews with Five (5) out of Fifty-Four (54) residents they are provided with a comfortable temperature inside the facility. Five (5) out of Forty-Six (46) staff members stated they are comfortable with the temperature in the facility. Based on LPA's observations during complaint visits on 12/06/2023 and 12/07/2023, the facility has comfortable temperature. LPA requested records from of (1) Generator maintenance (log for the past three months); (2) A/C maintenance (log for the past three months); (3) Gas company maintenance (log for the past three months); (4) Facility maintenance of lighting of both floors (log for the past three months); (5) Records of maintenance of toilets, bathtub, sink, washer, dryer, kitchen, parking lot, facility lights, facility vents, gas, A/C, and other (log for the past three months); (6) Records of maintenance of A/C that has not worked or is not working at the time of this visit (log for the past three months) and (7) a written narrative stating the amount of months A/C has not been working. Based on information gathered, LPA did not find sufficient evidence to support allegation “Staff did not ensure the facility is kept at a comfortable temperature for residents in care.”

Regarding the allegation “Staff did not ensure resident's bathroom is in proper operation.” On 12/07/2023, LPA interviewed Five (5) out of Forty-Six (46) staff members. Five (5) out of Forty-Six (46) staff members denied the allegation that “Staff did not ensure resident's bathroom is in proper operation.” Five (5) out of Forty-Six (46) staff members stated that there is daily cleaning done for the residents’ room, bathroom, as well as the general facility. Five (5) out of Forty-Six (46) staff members also stated that some days some of the residents don’t allow any one in their rooms to clean in for whatever reason. But the facility is cleaned daily. Five (5) out of Forty-Six (46) staff members all denied the allegation and asserted that the bathrooms are cleaned daily by housekeeping. Continued on 9099-C

SUPERVISOR'S NAME: Ulysses Coronel	TELEPHONE: (323) 400-7397
LICENSING EVALUATOR NAME: David Espana	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 12/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/07/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 11-AS-20231128143936

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: VISTA VERANDA ASSISTED LIVING	FACILITY NUMBER: 197608044
	VISIT DATE: 12/07/2023

NARRATIVE

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LPA interviewed Five (5) out of Fifty-Four (54) residents about the “Staff did not ensure resident's bathroom is in proper operation.” LPA interviewed Five (5) out of Fifty-Four (54) residents and of the Five (5) interviewed the majority stated that they did not have an issue with staff not cleaning their room or bathroom. Five (5) out of Fifty-Four (54) residents stated that they were satisfied with the housekeeping of the facility.

Based on interviews, observations, and records reviewed there is insufficient evidence to support the allegation “Staff did not ensure resident's bathroom is in proper operation.” 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 allegations are Unsubstantiated.

Exit interview conducted. A copy of the complaint report and appeal right was provided to Administrator, Jesse Loera-Mota.

SUPERVISOR'S NAME: Ulysses Coronel	TELEPHONE: (323) 400-7397
LICENSING EVALUATOR NAME: David Espana	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 12/07/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/07/2023

LIC9099 (FAS) - (06/04)

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