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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197608029
Report Date: 08/21/2025
Date Signed: 08/25/2025 10:45:53 AM

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
08/11/2025 and conducted by Evaluator Lizeth Villegas
COMPLAINT CONTROL NUMBER: 11-AS-20250811140929
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: 250DATE:
08/21/2025
UNANNOUNCEDTIME BEGAN:
08:51 AM
MET WITH:Executive DirectorTIME COMPLETED:
11:42 AM
ALLEGATION(S):
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Facility staff did not provide adequate food service to resident in care.
INVESTIGATION FINDINGS:
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On 08/21/25 Licensing Program Analyst (LPA) Villegas conducted an initial complaint visit regarding the allegation(s) above. LPA met with Executive Director Suzette Johnson (S1) as the purpose of today’s visit was explained.

The investigation consisted of the following: On 08/21/25 LPA Villegas obtained copies of the staff and resident roster, and requested the following documents for resident #1 (R1) admission agreement dated: 11/19/24, physicians report dated: 02/06/25 , preplacement appraisal dated: 11/19/24, needs and service plan dated:11/19/24. On 08/19/25 LPA conducted interview with Resident #1 (R1), and on 08/21/25 LPA conducted interview with staff #1-2 (S1-S2) regarding the allegation above.

The investigation revealed the following:
Allegation: Facility staff did not provide adequate food service to resident in care.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Lizeth Villegas
LICENSING EVALUATOR SIGNATURE:

DATE: 08/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/21/2025
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-20250811140929
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: 08/21/2025
NARRATIVE
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It is being alleged that facility kitchen does not provide lunch to go when requested.
On 08/19/25 LPA conducted interview with R1 regarding the allegation above, R1 reported the allegation is being addressed however R1 has been dealing with the allegation above for 3 months. on 08/21/25 LPA conducted interview with S1-S2 regarding the allegation above, 2 of 2 staff interviewed denied the allegation above, Per 2 of 2 staff interviewed residents have requested to go meals and the kitchen staff has completed the request. Additionally 2 of 2 staff interviewed reported that the requested packed meal are not always picked up by R1. 1 of 2 staff interviewed reported that the kitchen cooks big quantities of food to ensure that residents who are out during scheduled meal services can have food available upon their arrival. On 08/21/25 LPA reviewed the admission agreement page A-3 letter E titled meals, upon review of the admission agreement, LPA did not observe any documentation stating that the facility will provide packed meals for residents in care.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated.

Exit interview conducted, and a copy of this report was provided.
SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Lizeth Villegas
LICENSING EVALUATOR SIGNATURE:

DATE: 08/21/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/21/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2