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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197608029
Report Date: 07/10/2025
Date Signed: 07/10/2025 03:03:08 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO 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
06/25/2025 and conducted by Evaluator Jose Anguiano
PUBLIC
COMPLAINT CONTROL NUMBER: 11-AS-20250625084748
FACILITY NAME:VISTA DEL MAR SENIOR LIVINGFACILITY NUMBER:
197608029
ADMINISTRATOR:SUZETTE S. JOHNSONFACILITY TYPE:
740
ADDRESS:3360 MAGNOLIA AVENUETELEPHONE:
(562) 595-1559
CITY:LONG BEACHSTATE: CAZIP CODE:
90806
CAPACITY:300CENSUS: 252DATE:
07/10/2025
ANNOUNCEDTIME BEGAN:
02:14 PM
MET WITH:Suzette JohnsonTIME COMPLETED:
03:15 PM
ALLEGATION(S):
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Staff did not keep the facility free of rodents
INVESTIGATION FINDINGS:
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On 07/10/2025 Licensing Program Analyst (LPA) Jose Anguiano conducted a subsequent visit to deliver findings regarding the above allegation; this report supersedes the investigation report that was delivered on 07/02/2025. The purpose of this report is to provide additional information gathered during the investigation. LPA met with Suzette Johnson and the purpose of the visit was explained. LPA was granted entry to the facility.
Investigation consisted of the following:
On 07/01/2025 at approximately 1:50 PM, LPA Anguiano interviewed 10 staff members (S1–S10). Around 3:00 PM, LPA conducted inspections of ten resident rooms: 204, 259, 265, 253, 246, 211, 112, 135, and 138 (seven rooms on the second floor and three on the first floor), and interviewed 11 out of 251 residents (R2-R11). On 07/02/2025 at approximately 8:40 AM, LPA Anguiano conducted a physical plant inspection of the kitchen, and dining room and conducted record reviews.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Jose Anguiano
LICENSING EVALUATOR SIGNATURE:

DATE: 07/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/10/2025
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 11-AS-20250625084748
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 DEL MAR SENIOR LIVING
FACILITY NUMBER: 197608029
VISIT DATE: 07/10/2025
NARRATIVE
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On 07/09/2025 around 9:00 AM, LPA interviewed Resident (R1).
Investigation revealed the following:
Interviews conducted revealed the following: 9 out of the 10 staff members did not agree with the allegation, S1 stated that the facility has pest control measures in place and is currently in preventative mode. S2 indicated that kitchen cleaning is performed regularly. 9 out of the 10 residents did not agree with the allegation. R1 indicated that mice have been seen however had been taken care of in a slow manner when it’s brought up to the staff. LPA observations revealed the following: No live rodents were observed at the time of the visits. Records review revealed the following: LPA Anguiano reviewed a Dewey Pest Control Service Agreement, which indicated proof of an annual service contract. This contract indicated that the services are performed monthly on Wednesday’s. Additionally, a review of the Dewey Pest Control Service Log, covering the period from March 1, 2025, and April 29, 2025, confirmed that treatment services are being performed monthly.

During this investigation, LPA did not find sufficient evidence to support the above-mentioned allegation. Based on the evidence gathered, interviews conducted, and records reviewed, although the allegation “staff did not keep the facility free of rodents” 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.

An exit interview was conducted, and a copy of the Complaint Report was given to Suzette Johnson.
SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Jose Anguiano
LICENSING EVALUATOR SIGNATURE:

DATE: 07/10/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/10/2025
LIC9099 (FAS) - (06/04)
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