197608029-4-9-2026-11-AS-SCIS-DU92UW-20260519174258

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608029
Report Date: 04/09/2026
Date Signed: 04/09/2026 03:14:29 PM

Substantiated

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
03/25/2026 and conducted by Evaluator Lizeth Villegas

COMPLAINT CONTROL NUMBER: 11-AS-20260325122703

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: 242	DATE:	04/09/2026
		UNANNOUNCED	TIME BEGAN:	10:44 AM
MET WITH:	Executive Director Suzette Johnson		TIME COMPLETED:	03:20 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff did not keep facility free of vermin.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

On 04/09/26 Licensing Program Analyst (LPA) Villegas conducted a subsequent complaint visit regarding the allegation(s) above. LPA met with Executive Director as the purpose of today’s visit was explained.

The investigation consisted of the following: On 04/01/26 LPA Villegas obtained copies of the staff and resident roster, and copies of the following documents for Resident #1 (R1) Emergency ID form, pre placement appraisal dated: 02/20/25, Admission agreement dated: 02/18/25 , resident assessment dated: 03/05/25, Physicians report dated: 02/13/25, service plan dated: 06/17/25, updated service plan dated 03/26, shower schedule, facility notes dated: 03/2026, facilities laundry schedule, pest control service logs dated: On 01/2026-04/2026. On 04/01/26 from 10:00 am- 12pm LPA conducted Interviews with Residents #2-10 (R2-R10). On 04/01/26 LPA was unable to interview R1 as R1 was out of the facility at the time of visit. On 04/01/26 LPA conducted interviews with staff #1-3 (S1-S3) and conducted a tour of the facility. On 04/09/26 LPA conducted interviews with staff #4-6 (S4-S6). On 04/09/26 at 2pm LPA conducted interview with R1.

Substantiated

Estimated Days of Completion:

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Lizeth Villegas
LICENSING EVALUATOR SIGNATURE:	DATE: 04/09/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/09/2026

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 5

Control Number 11-AS-20260325122703

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: 04/09/2026

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

The investigation revealed the following:

Allegation: Staff did not keep facility free of vermin.

It is alleged that the facility has a rat problem as rat feces have been observed at the facility. On 04/01/26 and 04/09/26 LPA conducted Interviews with R1-R10 regarding the allegation above. 8 of the 10 residents interviewed denied the allegation above, 2 of the 10 residents interviewed confirmed the allegation above. 10 of 10 residents interviewed confirmed that the facility is getting treated by pest control. On 04/01/26 and 04/09/26 LPA conducted interviews with S1-S6. 4 of the 6 staff interviewed denied the allegation above, 2 of 6 staff interviewed confirmed the allegation above and reported seeing mice at the facility. 5 of the 6 staff confirmed that pest control services is coming out to service the facility. 1 of the 6 staff interviewed reported having no knowledge of pest control servicing the facility. On 04/01/26 LPA observed pest control to be servicing the facility at the time of the visit. On 04/01/26 LPA conducted a review of pest control service report dated: 3/25/26. Per the report, 20 rooms were serviced, interior and exterior inspected and baited, no activity found, EZ snaps are inspected each time facility is serviced, sanitation conditions listed as Fair. On 04/09/26 while LPA walked down facility hallway LPA observed a live cockroach.

Based on LPAs observations and interviews which were conducted record review(s), the preponderance of evidence standard has been met, therefore the above allegation(s) is found to be substantiated. California Code of Regulations, Title 22, Division (6) and Chapter (8) are being cited on the attached LIC 9099D.

Division (6) and Chapter (8) are for RCFE

Exit interview conducted, appeal rights explained, and a copy of this copy is provided.

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Lizeth Villegas
LICENSING EVALUATOR SIGNATURE:	DATE: 04/09/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/09/2026

LIC9099 (FAS) - (06/04)

Page: 2 of 5

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
03/25/2026 and conducted by Evaluator Lizeth Villegas

COMPLAINT CONTROL NUMBER: 11-AS-20260325122703

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: 242	DATE:	04/09/2026
		UNANNOUNCED	TIME BEGAN:	10:44 AM
MET WITH:	Executive Director Suzette Johnson		TIME COMPLETED:	03:20 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff left resident in a soiled diaper for a long period of time.
Staff did not ensure that residents clothing was change.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Lizeth Villegas
LICENSING EVALUATOR SIGNATURE:	DATE: 04/09/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/09/2026

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

LIC9099 (FAS) - (06/04)

Page: 4 of 5

Control Number 11-AS-20260325122703

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: 04/09/2026

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

The investigation revealed the following:

Allegation: Staff left resident in a soiled diaper for a long period of time.

It is alleged that resident in care is left in a soiled diaper as staff are not using residents’ diapers located in residents dresser. On 04/01/26 and 04/09/26 LPA conducted Interviews with R1-R10 regarding the allegation above. 6 of the 10 residents interviewed denied the allegation above and reported they change themselves when soiled. 3 of the 10 residents interviewed denied the allegation above and reported they have not been left soiled as staff are assisting. 1 of the 10 residents interviewed confirmed the allegation above and reported being left soiled a few times by staff. Additionally, 7 of the 10 residents interviewed denied needing assistance with incontinence care, 3 of the 10 residents interviewed confirmed needing assistance with incontinence care. On 04/01/26 and 04/09/26 LPA conducted interviews with S1-S6 regarding the allegation above. 2 of the 6 staff interviewed reported being unaware of the allegation above, 2 of the 6 staff interviewed denied the allegation above, 2 of the 6 staff interviewed confirmed the allegation above and reported that residents have been found to be soiled upon arrival to the morning shift. On 04/01/26 LPA conducted a review of R1s’ preplacement appraisal dated: 02/20/25 which indicated R1 can toilet self. Per service plan dated: 06/17/25 R1 can toilet self. On 04/01/26 LPA observed an updated service plan dated March 2026 that R1’s responsible party has not signed.

Allegation: Staff did not ensure that residents’ clothing was changed.

It is alleged that resident in care is left in the same clothing. On 04/01/26 and 04/09/26 LPA conducted Interviews with R1-R10 regarding the allegation above. 10 of the 10 residents interviewed denied the allegation above and reported having clean clothes available after bathing. On 04/01/26 and 04/09/26 LPA conducted interviews with S1-S6 regarding the allegation above. 5 of the 6 staff denied the allegation above, and 1 of the 6 staff interviewed reported being unaware of the allegation above. On 04/01/26 LPA conducted a review of R1s’ preplacement appraisal dated: 02/20/25 which indicated R1 can bath/shower self without assistance, dressing- self, grooming- partially depends on others. Per service plan dated: 06/17/25 R1 can dress- self-care, grooming- verbal queuing and set up. Per shower schedule, R1 is scheduled 2x a week Tuesday and Friday mornings. Per facilities laundry schedule, R1's laundry day is scheduled for Wednesday mornings. On 04/01/26 LPA observed an updated service plan dated 03/26 that R1’s responsible party has not signed.

Athough 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: 04/09/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/09/2026

LIC9099 (FAS) - (06/04)

Page: 5 of 5

Control Number 11-AS-20260325122703

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
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 04/09/2026

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 04/30/2026 Section Cited CCR 87303(a)	1 2 3 4 5 6 7	87303 Maintenance and Operation (a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors.	1 2 3 4 5 6 7	Executive Director to submit plan to LPA by POC due date detailing what the facility is going to do regarding pest control throughout the facility. What measure will be added to cleaning precedures to ensure pest at the facility is under control to ensure residents health and safety.
	8 9 10 11 12 13 14	This deficiency was not not met as as LPA observed a live coackroach in facility hallway which poses a potential health and safety risk to residents in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Lizeth Villegas
LICENSING EVALUATOR SIGNATURE:	DATE: 04/09/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/09/2026

LIC9099 (FAS) - (06/04)

Page: 3 of 5