197608044-9-12-2024-11-AS-RORN-D9PMNB-20241003094515

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608044
Report Date: 09/12/2024
Date Signed: 09/12/2024 02:55:12 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

This is an official report of an unannounced visit/investigation of a complaint received in our office on
02/15/2023 and conducted by Evaluator Felisa Shirley

COMPLAINT CONTROL NUMBER: 11-AS-20230215153016

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:	0	CENSUS:	DATE:	09/12/2024
		UNANNOUNCED	TIME BEGAN:	11:10 AM
MET WITH:			TIME COMPLETED:	02:55 PM

ALLEGATION(S):

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Facility staff not providing resident medications as prescribed
Facility staff not safeguarding residents' belongings

INVESTIGATION FINDINGS:

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***Please Note: The facility was closed on 6/4/2024. All staff and residents were retained during the change in ownership.
Licensing Program Analyst (LPA) Felisa Shirley attempted to conduct an unannounced subsequent complaint visit to Vista Veranda Assisted Living facility. During that attempt, LPA Shirley learned that the facility had changed ownership and was now called Generations of Los Angeles. During phone call on 9/6/24, LPA Shirley learned that the facility retained some of Vista Verandas records but did not have access to all of them. As facility has new owners, findings could not be delivered as there was no authorized agent available for signature.
The investigation consisted of the following: An initial complaint visit was completed by LPA Pamela Bunker on 2/22/2023. On 9/6/24, LPA Felisa Shirley spoke with Cameron Johnson, Administrator of Generations of Los Angeles and was provided copies of, physicians report dated 9/9/23, for R1, Identification and Emergency Information dated 7/23/19 for R1, and Appraisal/Needs and Services dated 8/12/24 for R1.

con’d on LIC 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Stephanie Cifuentes	TELEPHONE: (661) 644-7743
LICENSING EVALUATOR NAME: Felisa Shirley	TELEPHONE: 323-981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 09/12/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/12/2024

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-20230215153016

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

FACILITY NAME: VISTA VERANDA ASSISTED LIVING	FACILITY NUMBER: 197608044
	VISIT DATE: 09/12/2024

NARRATIVE

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LPA Shirley requested copies of the Medication Administration Records from 1/2023 and 2/2023 and was told they were not available due to the change of ownership. On 9/6/24 LPA Shirley attempted interviews with staff S1-S3 and R1.

The investigation revealed the following:

Allegation - Facility staff not providing resident medications as prescribed.

On 9/6/24, at 12:33 pm, LPA Shirley attempted to interview by phone former Vista Veranda Assisted Living staff, S1-S3. S-3 was not available. LPA Shirley asked S1 and S2 if facility provided residents their medications as prescribed. Of those interviewed, 2 out of 2 staff answered yes. At 12:55 pm, LPA attempt to interview R1 by phone, due to his diagnosis, R1 could not be interviewed. Due to the facility’s ownership change, LPA was unable to obtain medication records and interview all involved parties and therefore the department was unable to complete a full investigation.

Based on interviews and records reviewed, there is insufficient evidence to support the allegation that Facility staff not providing resident medications as prescribed. 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.

con'd on 9099-C

SUPERVISOR'S NAME: Stephanie Cifuentes	TELEPHONE: (661) 644-7743
LICENSING EVALUATOR NAME: Felisa Shirley	TELEPHONE: 323-981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 09/12/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/12/2024

LIC9099 (FAS) - (06/04)

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Control Number 11-AS-20230215153016

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

FACILITY NAME: VISTA VERANDA ASSISTED LIVING	FACILITY NUMBER: 197608044
	VISIT DATE: 09/12/2024

NARRATIVE

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Allegation - Facility staff not safeguarding residents’ belongings.

On 9/6/24, at 12:33 pm, LPA Shirley attempted to interview by phone former Vista Veranda Assisted Living staff, S1-S3. S-3 was not available. LPA Shirley asked S1 and S2 if facility staff safeguarded residents belongings? Of those interviewed, 2 out of 2 staff answered yes. At 12:55 pm, LPA attempt to interview R1 by phone but due to diagnosis, R1 could not be interviewed. Due to the facility’s ownership change, LPA was unable to obtain medication records and interview all involved parties and therefore the department was unable to complete a full investigation.

Based on interviews and records reviewed, there is insufficient evidence to support the allegation that the Facility staff not safeguarding resident’s belongings. 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.

No deficiencies were cited.

An exit interview was not conducted because the facility has closed. A hard copy of this report will be mailed to last known address of Licensee.

SUPERVISOR'S NAME: Stephanie Cifuentes	TELEPHONE: (661) 644-7743
LICENSING EVALUATOR NAME: Felisa Shirley	TELEPHONE: 323-981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 09/12/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/12/2024

LIC9099 (FAS) - (06/04)

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