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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197608044
Report Date: 04/19/2021
Date Signed: 04/20/2021 07:48:31 AM



STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office,
, CA
This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/22/2019 and conducted by Evaluator Angelica Rea
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20190722100603
FACILITY NAME:VISTA VERANDA ASSISTED LIVINGFACILITY NUMBER:
197608044
ADMINISTRATOR:MARCELLA CALVILLOFACILITY TYPE:
740
ADDRESS:3540 MARTIN LUTHER KING, JR.TELEPHONE:
(310) 638-4113
CITY:LYNWOODSTATE: CAZIP CODE:
90262
CAPACITY:178CENSUS: 95DATE:
04/19/2021
UNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Nishith ModiTIME COMPLETED:
01:00 PM
ALLEGATION(S):
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Facility staff is misallocating resident's funds
Facility is in disrepair
Facility has pests
Facility staff fail to treat resident with dignity and respect
Facility staff mismanages resident's medications
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Angelica Rea conducted another complaint visit for the allegation(s) 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 Administrator, Nishith Modi.

The investigation consisted of the following : interview(s) with Staff #1- Staff #3, Resident #1 - Resident #8, review of of pest control invoices, elevator maintenance invoices, and specific documents from Resident #9's file.

Regarding the allegation that facility staff is misallocating resident's funds, staff interviewed denied the allegation. Staff stated that Resident #9 was paying the SSI rate, and also received Personal and Incidental funds. LPA reviewed Record of Resident #9's cash resources, and observed that Resident #9's funds were properly accounted for. Residents interviewed were unable to corroborate the allegation. They stated that they receive their funds, and staff are not missallocating their funds.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Fernando FierrosTELEPHONE: (323) 981-3981
LICENSING EVALUATOR NAME: Angelica ReaTELEPHONE: (323) 980-4929
LICENSING EVALUATOR SIGNATURE:

DATE: 04/19/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/19/2021
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 2
Control Number 28-AS-20190722100603
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office,
, CA
FACILITY NAME: VISTA VERANDA ASSISTED LIVING
FACILITY NUMBER: 197608044
VISIT DATE: 04/19/2021
NARRATIVE
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Regarding the allegation that the facility is in disrepair, specifically that the facility has broken elevators. LPA observed on initial visit, that the elevator was working. LPA reviewed the most recent elevator maintenance invoice, and noted that a repair was made on 6/8/19. Staff interviewed stated that the elevator has broken down in the past, but they have it repaired immediately. Residents interviewed were unable to corroborate the allegation. 6 out of 8 residents interviewed stated that the elevator is working and it is not an issue for them.

Regarding the allegation that the facility has pests, specifically cockroaches. LPA toured facility on initial visit, and did not observe any cockroaches. LPA reviewed recent pest control invoices, and did not note a current pest control problem. Staff interviewed stated that they do not have a pest control problem, and they have a contract with a pest control company as a preventative measure. Residents interviewed were unable to corroborate the allegation. 5 out of 8 residents interviewed stated that they have not observed cockroaches at the facility.

Regarding the allegation that facility staff failed to treat resident with dignity and respect, staff interviewed denied the allegation. Staff interviewed stated that they treat all residents with dignity and respect. Residents interviewed were unable to corroborate the allegation. 8 out of 8 residents stated that they are treated well by staff.

Regarding the allegation that facility staff mismanages resident's medications, staff interviewed denied the allegation. Staff stated that resident #9 always accused staff of stealing her medication. Staff stated that resident #9 wanted more medication than what was prescribed to her. Resident's interviewed were unable to corroborate the allegation. 8 out of 8 residents stated that they did not have any problems with their medication management.

Based on LPA's observations and interviews, investigation revealed: Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegations are unsubstantiated.

No Deficiencies cited under California Code of Regulations Title 22. An exit Interview was conducted via telephone with the administrator and a hardcopy was provided via email for signature. Signatures on hardcopy.
SUPERVISOR'S NAME: Fernando FierrosTELEPHONE: (323) 981-3981
LICENSING EVALUATOR NAME: Angelica ReaTELEPHONE: (323) 980-4929
LICENSING EVALUATOR SIGNATURE:

DATE: 04/19/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/19/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 2