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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197608029
Report Date: 08/22/2025
Date Signed: 08/22/2025 08:26:41 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
08/20/2025 and conducted by Evaluator Ernand Dabuet
PUBLIC
COMPLAINT CONTROL NUMBER: 11-AS-20250820152434
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:
08/22/2025
UNANNOUNCEDTIME BEGAN:
08:26 AM
MET WITH:Suzette JohnsonTIME COMPLETED:
04:27 PM
ALLEGATION(S):
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Staff are not properly addressing pest infestation in the facility.
INVESTIGATION FINDINGS:
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On August 22, 2025, the California Department of Social Services/Community Care Licensing (CDSS/CCL) Licensing Program Analyst (LPA) Ernand Dabuet conducted an initial unannounced complaint visit. Suzette Johnson, Executive Director, greeted the LPA. (LPA) explained that the purpose of the visit is to investigate the allegation mentioned above.

The investigation included interviews, a collection of records, and a tour of the facility. Interviews were conducted with Resident #1 through Resident #9 (R1-R9), Staff #1 through Staff #6 (S1-S6). The Department reviewed several documents, including the Facility Resident Roster (dated 08/22/25), Personnel Report LIC 500 (dated 08/22/25), Dewey Pest Control Service Agreement (dated 12/20/24 & 06/17/25), Dewey Pest Control Control Sevice Log (dated 06/20/25 & 08/19/25) and (R1's) Physicians Report LIC 602A (dated 05/25/25) as well as other pertinent records associated with this complaint.

(Evaluation Report continues LIC 9099-C)
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ernand Dabuet
LICENSING EVALUATOR SIGNATURE:

DATE: 08/22/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/22/2025
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 4
Control Number 11-AS-20250820152434
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: 08/22/2025
NARRATIVE
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INVESTIGATION REVEALED THE FOLLOWING:

Allegation #1: Staff are not properly addressing pest infestation in the facility.

The complaint states that the staff are not adequately addressing the pest infestation in the facility. It has been reported that Resident #1 (R1) is facing a vermin infestation in their room. Despite multiple attempts to contact the person responsible for resolving the issue, (R1) has been unable to obtain assistance. Additionally, (R1) must deal with exterminating various small and large bugs daily and have experienced pest bites. No further details regarding this matter have been provided.

On August 22, 2025, between 09:05 AM and 11:09 AM, the Department interviewed staff members identified as Staff #1 through Staff #6 (S1-S6). Six (6) out of the six (6) staff members expressed that they could not support this claim. (S1-S2) emphasizes its commitment to ensuring the safety and well-being of residents by implementing effective, environmentally friendly pest management measures. The facility has an active service agreement with a reputable pest control company that performs weekly pest control services. (S2) stated that these scheduled services treat ten rooms and common areas each week. (S1-S2) reported that (R1's) room was serviced, with treatments conducted on June 20, 2025, and August 19, 2025, along with adjacent rooms on the same floor. (S1-S6) noted that (R1) has not recently informed staff about any pest issues and prohibits them from entering (R1's) room for cleaning and care assistant services.

Furthermore, all six staff members interviewed reported that (R1) has made it clear that they will not permit anyone to enter their room without their presence. They have stated that if this boundary is not respected, they will not hesitate to contact law enforcement or legal counsel to enforce their rights. This situation creates challenges for the facility in maintaining a safe and healthy environment for (R1).

On August 22, 2025, between 10:45 AM and 12:08 PM, the Department interviewed resident members identified as Resident #1 through Resident #9 (R1-R9). Seven (7) out of the nine (9) residents could not validate this allegation. Residents from (R3-R9) have stated that they have no issues or concerns as they have not encountered any pest in their rooms or common areas. Additionally, they have observed pest control professionals actively performing treatments throughout the premises, ensuring a safe and pest-free environment for everyone. (R10), identified as( R1's) roommate, declined to be interviewed.

(Evaluation Report continues LIC 9099-C)

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ernand Dabuet
LICENSING EVALUATOR SIGNATURE:

DATE: 08/22/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/22/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 11-AS-20250820152434
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: 08/22/2025
NARRATIVE
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(R1-R2) expressed concerns regarding a pest issue in their rooms and mentioned that they have informed the staff, but no action has been taken yet. (R1) indicated that they have reported the issue to the care staff daily; however, (R1) was unable to recall the names of the staff members involved. Additionally, (R1) did not remember if the room had been treated on June 20, 2025, or August 19, 2025. (R1) verified that staff must not enter the room without the presence of (R1), nor should they provide any cleaning or care assistance services without (R1's) presence. This rule is crucial to maintain proper standards according to (R1's) preference. (R1) stated she has not seek any medical assistance for bites due to pest problems.

The Department inspected the facility on August 22, 2025, focusing on the first floor, second floor, and common areas. Rooms inspected included #284, # 285, 286, 287, and #289. The rooms were found to be maintained and clean. The rooms are in order to prevent pest infestations, ensuring a comfortable environment for everyone. Housekeeping and maintenance staff were observed carrying out their responsibilities.

(R1's) room was found to be disorganized, with clothes and tableware left soaked for an extended period. There was also standing water, which could attract and create a breeding ground for flies. Additionally, uncovered food packages and drinks left in glassware are likely to attract various types of flies. The Department did not observed any sign vermin or pest infestation. The Department did not observed what appear to be pest bites on (R1).

The Department reviewed a Dewey Pest Control Service Agreement dated December 12, 2024, and another dated June 17, 2025, which provided evidence of an annual service contract. This contract indicated that ten service visits were performed each month, totaling 40 treatments per month.

Additionally, an examination of the Dewey Pest Control Service Log, covering the period from June 20, 2025, to August 19, 2025, confirmed that service treatments were performed for (R1's) room. Telecommunications records from July 13, 2025, indicated that (R1) had prohibited staff from entering the room for cleaning assistance.

Further review conducted on (R1's) Physician's Report LIC 624 A and the Service Plans dated May 25, 2025, and June 21, 2025.

(Evaluation Report continues LIC 9099-C)

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ernand Dabuet
LICENSING EVALUATOR SIGNATURE:

DATE: 08/22/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/22/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 11-AS-20250820152434
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: 08/22/2025
NARRATIVE
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Based on the information gathered, there is not enough evidence to support the allegation mentioned above.

Based on the information collected from the facility inspection, observations, interviews, and records analysis, the Department found no evidence to support the above allegation. The allegation may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred. Therefore, the allegation is Unsubstantiated.

An exit interview was conducted with Suzette Johnson, and copies of the reports were provided.

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ernand Dabuet
LICENSING EVALUATOR SIGNATURE:

DATE: 08/22/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/22/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 4