197608029-10-8-2025-11-AS-JHAD-DN83QB-20251107172653

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608029
Report Date: 10/08/2025
Date Signed: 10/08/2025 03:15:42 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
10/01/2025 and conducted by Evaluator Lizeth Villegas

COMPLAINT CONTROL NUMBER: 11-AS-20251001161907

FACILITY NAME:	VISTA DEL MAR SENIOR LIVING		FACILITY NUMBER:	197608029
ADMINISTRATOR:	SUZETTE JOHNSON		FACILITY TYPE:	740
ADDRESS:	3360 MAGNOLIA AVENUE		TELEPHONE:	(562) 595-1559
CITY:	LONG BEACH	STATE: CA	ZIP CODE:	90806
CAPACITY:	300	CENSUS: 249	DATE:	10/08/2025
		UNANNOUNCED	TIME BEGAN:	01:21 PM
MET WITH:	Resident Care Director Sidonia Cordis		TIME COMPLETED:	03:25 PM

ALLEGATION(S):

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Staff are not providing adequate care and supervision to resident in care.
Facility staff failed to provide transportation to resident to and from medical appointment.

INVESTIGATION FINDINGS:

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On 10/08/25 Licensing Program Analyst (LPA) Villegas conducted a subsequent complaint visit regarding the allegation(s) above. LPA met with Sidonia Cordis as the purpose of today’s visit was explained.

The investigation consisted of the following: On 10/07/25 LPA Villegas obtained copies of the staff and resident roster, and copies of the following documents for Resident #1 (R1) Face sheet, Preplacement appraisal dated: 4/30/24, Service plan dated: 9/13/25, Physicians report dated: 5/24/24 , Physicians orders, facility notes and Transportation policy. On 10/07/25 and 10/08/25 LPA conducted interviews with Staff #1-5 (S1-S5), and on 10/08/25 from 1:45pm-2:15 pm LPA conducted interviews with residents #2-10 (R2-R10). On 10/07/25 and 10/08/25 LPA attempted to conduct interview with R1, however R1 refused interview. On 10/08/25 LPA conducted a review of R1's file.

The investigation revealed the following:
Allegation: Staff are not providing adequate care and supervision to resident in care.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Lizeth Villegas
LICENSING EVALUATOR SIGNATURE:	DATE: 10/08/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/08/2025

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-20251001161907

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: 10/08/2025

NARRATIVE

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It is being alleged that residents in care are missing appointments due to staff not providing assist in a timely manner. On 10/07/25 and 10/08/25 LPA conducted interviews with S1-S5 regarding the allegation above. 5 of 5 residents interviewed denied the allegation above, per 5 of 5 staff residents have refused assistance and have refused to attend medical appointments. On 10/08/25 from 1:45 pm-2:15 pm LPA conducted interviews with R2-R10 regarding the allegation above. 9 of 9 residents interviewed denied the allegation above, 1 of 9 residents reported they have refused to attend scheduled medical appointment. On 10/07/25 and 10/08/25 LPA attempted to conduct interview with R1, however R1 refused interview. On 10/08/25 LPA conducted a review of R1's file. LPA conducted review of facility notes, LPA observed documentation indicating R1 has refused medical appointments on multiple occasions.

Allegation: Facility staff failed to provide transportation to resident to and from medical appointment.
It is being alleged that the facility is not providing residents in care with transportation to and from medical appointments. On 10/07/25 and 10/08/25 LPA conducted interviews with S1-S5 regarding the allegation above, 5 of 5 residents interviewed denied the allegation above. Per 5 of 5 staff, some residents have Access accounts, some residents are transported by families, and some obtain assistance by the facility.
On 10/08/25 from 1:45 pm-2:15 pm LPA conducted interviews with R2-R10 regarding the allegation above. 9 of 9 residents interviewed denied the allegation above, 5 of 9 residents reported having their own means of transportation, 1 of 9 residents reported the facility assist with all medical appointments, 1 of 9 residents is now aware of how they get to medical appointments, 2 of 9 residents reported that a physician comes to the facility to see them. On 10/07/25 and 10/08/25 LPA attempted to conduct interview with R1, however R1 refused interview. On 10/08/25 LPA conducted a review of R1's file. LPA conducted review of facility notes, LPA observed documentation indicating R1 has cancelled transportation arrangements on multiple occasions.

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: 10/08/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/08/2025

LIC9099 (FAS) - (06/04)

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