197608044-4-1-2021-11-AS-JHAD-BZSRWV-20210405132345

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608044
Report Date: 03/30/2021
Date Signed: 04/01/2021 09:31:23 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
03/26/2021 and conducted by Evaluator Ulysses Coronel

COMPLAINT CONTROL NUMBER: 11-AS-20210326095420

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: 94	DATE:	03/30/2021
		UNANNOUNCED	TIME BEGAN:	03:53 PM
MET WITH:	Nishith Modi		TIME COMPLETED:	05:00 PM

ALLEGATION(S):

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Resident locked in bedroom during the night
Staff did not provide between meal snacks for resident
Staff denied resident water
Staff are not bathing resident
Staff speak inappropriately to residents
Staff does not provide planned activities for residents at facility
Staff did not provide resident with clean linen
Resident's dresser in disrepair

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Ulysses Coronel initiated a complaint investigation for the allegations listed above. Due to the situation surrounding the Coronavirus Disease 2019 (COVID-19), and to implement mitigation measures, today’s complaint investigation was conducted telephonically with Nishith Modi, the administrator.

The investigation consisted of the following: On 03/29/2021 LPA Coronel conducted telephone interviews with the administrator, temporary manager (TM) Damion Anderson, caregiver supervisor Patricia Garcia and med tech Ruth Noriega staff. On 03/29/2021 LPA reviewed Vista Veranda's Daily Census Report.

The investigation revealed the following: On 03/29/2021, the administrator, the temporary manager (TM) Damion Anderson, caregiver supervisor Patricia Garcia and med tech Ruth Noriega denied that alleged victim P1 was a resident at the facility. TM stated that "I worked on this chart list and I did not see that name listed." On 03/29/2021 LPA reviewed the facility's daily census report and did not observe P1's name listed.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Ulysses Coronel	TELEPHONE: (951) 212-8917
LICENSING EVALUATOR SIGNATURE:	DATE: 03/30/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/30/2021

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 3

Control Number 11-AS-20210326095420

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: 03/30/2021

NARRATIVE

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On 03/29/2021 LPA reviewed the facility's daily census report and did not observe P1's name listed. Regarding the allegation "Resident locked in bedroom during the night". We have found that the complaint was unfounded, meaning that the allegation was false, could not have happened and/or is without reasonable basis. We have therefore dismissed the complaint.

On 03/29/2021, the administrator, the temporary manager (TM) Damion Anderson, caregiver supervisor Patricia Garcia and med tech Ruth Noriega denied that alleged victim P1 was a resident at the facility. TM stated that "I worked on this chart list and I did not see that name listed." On 03/29/2021 LPA reviewed the facility's daily census report and did not observe P1's name listed on the list of facility residents. regarding the allegation "Staff did not provide between meal snacks for resident". We have found that the complaint was unfounded, meaning that the allegation was false, could not have happened and/or is without reasonable basis. We have therefore dismissed the complaint.

On 03/29/2021, the administrator, the temporary manager (TM) Damion Anderson, caregiver supervisor Patricia Garcia and med tech Ruth Noriega denied that alleged victim P1 was a resident at the facility. TM stated that "I worked on this chart list and I did not see that name listed." On 03/29/2021 LPA reviewed the facility's daily census report and did not observe P1's name listed on the list of facility residents. regarding the allegation "Staff denied resident water". We have found that the complaint was unfounded, meaning that the allegation was false, could not have happened and/or is without reasonable basis. We have therefore dismissed the complaint.

On 03/29/2021, the administrator, the temporary manager (TM) Damion Anderson, caregiver supervisor Patricia Garcia and med tech Ruth Noriega denied that alleged victim P1 was a resident at the facility. TM stated that "I worked on this chart list and I did not see that name listed." On 03/29/2021 LPA reviewed the facility's daily census report and did not observe P1's name listed on the list of facility residents. regarding the allegation "Staff are not bathing resident". We have found that the complaint was unfounded, meaning that the allegation was false, could not have happened and/or is without reasonable basis. We have therefore dismissed the complaint.

On 03/29/2021, the administrator, the temporary manager (TM) Damion Anderson, caregiver supervisor Patricia Garcia and med tech Ruth Noriega denied that alleged victim P1 was a resident at the facility. TM stated that "I worked on this chart list and I did not see that name listed."

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Ulysses Coronel	TELEPHONE: (951) 212-8917
LICENSING EVALUATOR SIGNATURE:	DATE: 03/30/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/30/2021

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 11-AS-20210326095420

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: 03/30/2021

NARRATIVE

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On 03/29/2021 LPA reviewed the facility's daily census report and did not observe P1's name listed on the list of facility residents. regarding the allegation "Staff speak inappropriately to residents". We have found that the complaint was unfounded, meaning that the allegation was false, could not have happened and/or is without reasonable basis. We have therefore dismissed the complaint.

On 03/29/2021, the administrator, the temporary manager (TM) Damion Anderson, caregiver supervisor Patricia Garcia and med tech Ruth Noriega denied that alleged victim P1 was a resident at the facility. TM stated that "I worked on this chart list and I did not see that name listed." On 03/29/2021 LPA reviewed the facility's daily census report and did not observe P1's name listed on the list of facility residents. regarding the allegation "Staff does not provide planned activities for residents at facility". We have found that the complaint was unfounded, meaning that the allegation was false, could not have happened and/or is without reasonable basis. We have therefore dismissed the complaint.

On 03/29/2021, the administrator, the temporary manager (TM) Damion Anderson, caregiver supervisor Patricia Garcia and med tech Ruth Noriega denied that alleged victim P1 was a resident at the facility. TM stated that "I worked on this chart list and I did not see that name listed." On 03/29/2021 LPA reviewed the facility's daily census report and did not observe P1's name listed on the list of facility residents. regarding the allegation "Staff did not provide resident with clean linen". We have found that the complaint was unfounded, meaning that the allegation was false, could not have happened and/or is without reasonable basis. We have therefore dismissed the complaint.

On 03/29/2021, the administrator, the temporary manager (TM) Damion Anderson, caregiver supervisor Patricia Garcia and med tech Ruth Noriega denied that alleged victim P1 was a resident at the facility. TM stated that "I worked on this chart list and I did not see that name listed." On 03/29/2021 LPA reviewed the facility's daily census report and did not observe P1's name listed on the list of facility residents. regarding the allegation "Resident's dresser in disrepair". We have found that the complaint was unfounded, meaning that the allegation was false, could not have happened and/or is without reasonable basis. We have therefore dismissed the complaint.

An exit interview was conducted and hard copy was provided via email for signature.

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Ulysses Coronel	TELEPHONE: (951) 212-8917
LICENSING EVALUATOR SIGNATURE:	DATE: 03/30/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/30/2021

LIC9099 (FAS) - (06/04)

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