197608029-9-11-2025-11-AS-JHAD-DM4UP5-20251003154458

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608029
Report Date: 09/11/2025
Date Signed: 09/11/2025 03:38:47 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
09/04/2025 and conducted by Evaluator Lizeth Villegas

COMPLAINT CONTROL NUMBER: 11-AS-20250904103516

FACILITY NAME:	VISTA DEL MAR SENIOR LIVING		FACILITY NUMBER:	197608029
ADMINISTRATOR:	SUZETTE S. JOHNSON		FACILITY TYPE:	740
ADDRESS:	3360 MAGNOLIA AVENUE		TELEPHONE:	(562) 595-1559
CITY:	LONG BEACH	STATE: CA	ZIP CODE:	90806
CAPACITY:	300	CENSUS: 250	DATE:	09/11/2025
		UNANNOUNCED	TIME BEGAN:	09:01 AM
MET WITH:	Suzette Johnson		TIME COMPLETED:	03:41 PM

ALLEGATION(S):

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Staff are threatening resident.
Staff did not prevent resident from smoking in the room.
Staff did not prevent a resident from threatening another resident.

INVESTIGATION FINDINGS:

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On 09/11/25 at 9:00 am Licensing Program Analyst (LPA) Villegas conducted a subsequent complaint visit regarding the allegation(s) above. LPA met with Suzette Johnson as the purpose of today’s visit was explained.
The investigation consisted of the following: On 09/10/25 LPA Villegas obtained copies of the staff and resident roster, and copies of the following documents for Resident #1- 2(R1-R2): face sheets, Pre-appraisals, Service plans, physicians reports, medication administration record (MAR) for August and September 2025, ALW info for R1, admission agreements and facility notes. On 09/10/25 and 09/11/25 LPA conducted Interviews with Residents #1-11 (R1-R11). On 09/10/25 and 09/11/25 LPA conducted interviews with staff #1-7 (S1-S7). On 09/11/25 LPA conducted interview with witness #1 (W1).
The investigation revealed the following:
Allegation: Staff are threatening residents.
It is being alleged that staff are threatening residents in care. On 09/10/25 from 9:30 am- 12pm LPA conducted Interviews with R1-R11 regarding the allegation above. 11 of 11 residents denied the allegation.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Lizeth Villegas
LICENSING EVALUATOR SIGNATURE:	DATE: 09/11/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/11/2025

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 11-AS-20250904103516

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: 09/11/2025

NARRATIVE

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On 09/10/25 and 09/11/25 LPA conducted interviews with S1-S7 regarding the allegation above, 7 of the 7 staff interviewed denied the allegation above. On 09/11/25 LPA conducted interview with W1 regarding the allegation above, per W1 there are no safety concerns.

Allegation: Staff did not prevent residents from smoking in their bedroom.

It is being alleged that facility staff are allowing residents in care to smoke cigarettes in their bedroom and bedroom balcony. On 09/10/25 and 09/11/25 LPA conducted Interviews with R1-R11 regarding the allegation above. 10 of the 11 residents interviewed denied the allegation above. 1 of the 11 residents interviewed confirmed the allegation above and reported calling staff members for help, however, by the time the staff arrives to the bedroom the resident smoking is no longer in the bedroom and there is no evidence that smoking occurred. On 09/10/25 and 09/11/25 LPA conducted interviews with S1-S7 regarding the allegation above, 6 of the 7 staff interviewed denied the allegation above, however report that residents that have been caught smoking in a bedroom are redirected to the smoking patio and are reminded of the facility rules. 1 of the 7 staff interviewed did not have any information regarding the allegation above. On 09/11/25 LPA conducted interview with W1 regarding the allegation above, per W1 there are no safety concerns. On 09/11/25 LPA conducted review of facility notes dated 8/11/25 and 09/03/25, facility notes indicated that resident in care has made reports of peer smoking in the bedroom, however staff have not observed any proof that cigarette smoking has occurred.

Allegation: Staff did not prevent a resident from threatening another resident.

It is being alleged that facility staff are not calling the police when a resident is threatened by a peer. On 09/10/25 and 09/11/25 LPA conducted Interviews with R1-R11 regarding the allegation above. 9 of the 11 residents interviewed denied the allegation above and reported feeling safe at the facility. 1 of the 11 residents interviewed denied the allegation above, however stated that a peer has threatened resident but it was not reported to staff. 1 of the 11 residents interviewed confirmed the allegation above and stated that staff was able to assist but the police was not called. On 09/10/25 and 09/11/25 LPA conducted interviews with S1-S7 regarding the allegation above, 7 of the 7 staff interviewed denied the allegation above. On 09/11/25 LPA conducted interview with W1 regarding the allegation above, per W1 there are no safety concerns.

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: 09/11/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/11/2025

LIC9099 (FAS) - (06/04)

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