197608029-4-22-2026-11-AS-SCIS-DU8VZQ-20260519165308

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608029
Report Date: 04/22/2026
Date Signed: 04/22/2026 12:46:46 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
04/17/2026 and conducted by Evaluator Felisa Shirley

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20260417082655

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:	04/22/2026
		UNANNOUNCED	TIME BEGAN:	09:19 AM
MET WITH:	Executive Director, Suzette Johnson		TIME COMPLETED:	01:00 PM

ALLEGATION(S):

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Staff did not assist resident with dressing

INVESTIGATION FINDINGS:

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On 4/22/26, Licensing Program Analyst (LPA) Felisa Shirley conducted an unannounced visit to this facility. LPA was met by the Executive Director, Suzette Johnson and explained the purpose of the visit is to investigate and deliver findings for the allegations mentioned above. LPA was granted access to the facility.

The investigation consisted of the following:
On 4/22/26 LPA Felisa Shirley reviewed copies of the following records: Staff and Resident Roster, Medical Assessment for Residential Care Facilities for the Elderly, Service Plan 4/21/26, Service Plan 4/8/26, and Resident Assessment 4/8/26. LPA Felisa Shirley conducted a tour of the facility. LPA Shirley interviewed Staff 1 – Staff-5 (S1 – S5), and Resident -1 – Resident – 10 (R1-R10).

Con'd on 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Felisa Shirley
LICENSING EVALUATOR SIGNATURE:	DATE: 04/22/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/22/2026

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-20260417082655

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: 04/22/2026

NARRATIVE

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The investigation revealed the following:

Allegation: Staff did not assist resident with dressing

It is being reported that resident was not assisted with getting dressed. Resident was admitted to this facility 4/8/26. Per review of Admission Resident Assessment dated, 4/8/26, R1 was assessed as Independent, and self-care for level of assistance with dressing and grooming. LPA also observed the Service Plan for R1 dated 4/8/26 indicating resident as, Independent, self-care for both dressing and grooming. During interviews on 4/22/26, LPA Felisa Shirley spoke with a family member, W1. W1 stated she’d been contacted for a care plan meeting regarding R1. W1 stated that R1 was reassessed and R1 was reclassified as requiring complete, hands-on assistance with dressing and grooming. LPA Shirley reviewed new Service Plan for R1 dated 4/21/26. Service plan indicated that R1 requires full assistance with dressing in the morning and full assistance with undressing at bedtime.

LPA interviewed staff 1 – staff 5 (S-1 – S-5). Of those interviewed 5 out of 5 denied the allegation. LPA interviewed resident 1 – resident 10 (R1 – R10). Of those who interviewed 10 out of 10 denied the allegation.

Based on information gathered, LPA did not find sufficient evidence to support the allegation “Staff did not assist resident with dressing,” therefore, the allegation is unsubstantiated.

No deficiencies were cited for these allegations.

An exit interview was conducted and a copy of this report was provided to the Executive Director, Suzette Johnson.

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Felisa Shirley
LICENSING EVALUATOR SIGNATURE:	DATE: 04/22/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/22/2026

LIC9099 (FAS) - (06/04)

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