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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198602623
Report Date: 05/12/2020
Date Signed: 12/14/2022 05:42:42 PM

Unsubstantiated


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 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
02/14/2020 and conducted by Evaluator Bonnie Tao
COMPLAINT CONTROL NUMBER: 28-AS-20200214141430
FACILITY NAME:VISTA DEL MAR VILLASFACILITY NUMBER:
198602623
ADMINISTRATOR:CHEN, DERICKFACILITY TYPE:
740
ADDRESS:3049 EAST DEL MAR BLVDTELEPHONE:
(626) 215-1045
CITY:PASADENASTATE: CAZIP CODE:
91107
CAPACITY:6CENSUS: 4DATE:
05/12/2020
UNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:TIME COMPLETED:
05:00 PM
ALLEGATION(S):
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Staff sexually abused resident in care.
Resident sustained major injury due to staff neglect.
Staff hit resident.
Staff yell at residents.
Staff are not providing adequate food service.
Staff are mismanaging resident's medications.
Staff do not meet resident's needs.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Tao initiated a subsequent complaint investigation to deliver findings on 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 Licensee. LPA discussed the purpose of the investigation with Licensee, Christina Chen.

For the allegation of the facility that was sexually abused resident in care, residents, staff, and administrator were interviewed over the phone. They denied the allegation. According to the file review, the facility provided annual trainings, such as direct care, residents’ rights and care for dementia elderly, to staff. Based on interviews conducted and file review, the statement provided were inconsistent regarding the allegation listed above. There is insufficient evidence to support the allegation that facility staff was sexually abused resident in care.
(-continued in LIC 9099 -C)
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Wei Siew HoTELEPHONE: (323) 981-3969
LICENSING EVALUATOR NAME: Bonnie TaoTELEPHONE: (323) 981-3971
LICENSING EVALUATOR SIGNATURE:

DATE: 05/12/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/12/2020
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 28-AS-20200214141430
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 CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: VISTA DEL MAR VILLAS
FACILITY NUMBER: 198602623
VISIT DATE: 05/12/2020
NARRATIVE
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For the allegation that resident was sustained major injury due to staff neglect, residents, staff, and administrator were interviewed over the phone. They denied the allegation. The reporting party stated that was a person who possibly sustained major injury due to staff neglect. Since that person had passed away, LPA interviewed that person’s daughter. That incident, her mother climbed over the bed rail and fell out of her bed. Her mother passed away five months later and her cause of death was cardiopulmonary arrest and congestive heart failure. The daughter denied her mother was being neglected. According to the file review, the facility provided annual trainings, such as direct care and care for dementia elderly, to staff. Based on interviews conducted and file review, the statement provided were inconsistent regarding the allegation listed above. There is insufficient evidence to support the allegation that resident sustained major injury due to staff neglect.

For the allegation that the staff hit resident, residents, staff, and administrator were interviewed. The reporting party stated that was a person who possibly being hit by staff. LPA had a phone interview with that person. They all denied the allegation. Residents felt comfortable living at the facility. According to the file review, the facility provided annual trainings, such as direct care and residents’ right, to staff. Based on interviews conducted and file review, the statement provided were inconsistent regarding the allegation listed above. There is insufficient evidence to support the allegation that staff hit resident.

For the allegation that the staff yelled at residents, LPA interviewed residents, staff and administrator. Five out of six staff denied this allegation. Two out of and three residents denied this allegation. Residents felt comfortable with the relationship with staff. Based on interviews conducted and file review, the statement provided were inconsistent regarding the allegation listed above. There is insufficient evidence to support the allegation that staff yelled resident.

For the allegation that the staff did not provide adequate food services to residents, LPA interviewed residents, staff and administrator. They all denied this allegation. Residents said the food there was fine and enough to eat. Staff said the food were cooked fresh. As LPA observed during the initial visit, food supply, such as juice, milk, meat, fruit, cereal, snacks and vegetable, was plenty and the meal was cooked fresh at the facility. The family member agreed that the food there was fine and residents had enough to eat. Based on interviews conducted, the statement provided were inconsistent regarding the allegation listed above. There is insufficient evidence to support the allegation that staff are not providing adequate food service. (-continued in LIC 9099 C)

SUPERVISOR'S NAME: Wei Siew HoTELEPHONE: (323) 981-3969
LICENSING EVALUATOR NAME: Bonnie TaoTELEPHONE: (323) 981-3971
LICENSING EVALUATOR SIGNATURE:

DATE: 05/12/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/12/2020
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 28-AS-20200214141430
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 CNTR DR. ST 500
MONTEREY PARK, CA 91754
FACILITY NAME: VISTA DEL MAR VILLAS
FACILITY NUMBER: 198602623
VISIT DATE: 05/12/2020
NARRATIVE
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For the allegation that the staff mismanaged resident’s medications, LPA interviewed residents, staff and administrator over the phone. They all denied this allegation. LPA reviewed the resident’s medical records and did not see record of using the Over the counter medication Tylenol of 1000 mg or 400 mg of Ibuprofen. Staff said the residents’ medication was distributed as prescribed. Staff had annual training on medication. Based on interviews conducted and record review, the statement provided were inconsistent regarding the allegation listed above. There is insufficient evidence to support the allegation that staff are mismanaging resident’s medications.

For the allegation that the staff did not meet resident’s needs, LPA interviewed residents, staff and administrator. The reporting party said that was a person who’s care and needs may not be met while that person was living at the facility. LPA spoke with that person’s responsible party and had an interview. They all denied this allegation. Staff had training in elderly’s care and needs. As LPA observed during the initial visit, residents looked happy and able to get care as they responded in the interview. There is insufficient evidence to support the allegation that staff do not meet resident’s needs.

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.

A telephonic exit interview was conducted with Licensee. A hard copy of the report was emailed. Licensee was instructed to sign the LIC 9099 reports and return to LPA.

SUPERVISOR'S NAME: Wei Siew HoTELEPHONE: (323) 981-3969
LICENSING EVALUATOR NAME: Bonnie TaoTELEPHONE: (323) 981-3971
LICENSING EVALUATOR SIGNATURE:

DATE: 05/12/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/12/2020
LIC9099 (FAS) - (06/04)
Page: 3 of 3