<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197608029
Report Date: 05/01/2026
Date Signed: 05/01/2026 03:51:39 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
02/17/2026 and conducted by Evaluator Lizeth Villegas
COMPLAINT CONTROL NUMBER: 11-AS-20260217132633
FACILITY NAME:VISTA DEL MAR SENIOR LIVINGFACILITY NUMBER:
197608029
ADMINISTRATOR:SUZETTE JOHNSONFACILITY TYPE:
740
ADDRESS:3360 MAGNOLIA AVENUETELEPHONE:
(562) 595-1559
CITY:LONG BEACHSTATE: CAZIP CODE:
90806
CAPACITY:300CENSUS: 243DATE:
05/01/2026
UNANNOUNCEDTIME BEGAN:
10:16 AM
MET WITH:Executive Director Suzette JohnsonTIME COMPLETED:
04:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff did not provide adequate supervision, resulting in resident sustaining fractures
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 05/01/26 The Department 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 02/18/26 The Department obtained copies of the staff and resident roster, and copies of the following documents for Resident #1 (R1) Emergency ID form, pre-appraisal dated: 01/04/24, Physicians report dated: 04/21/2025, needs and service plan dated: 04/12/25, communication notes for February 2026, and unusual incident report dated: 02/15/26. On 03/02/26 The Department conducted interviews with staff #1-3 (S1-S3), and interviews with residents #1-2 (R1-R2). On 03/02/26 The Department reviewed police report from the Long Beach Police Department. On 03/03/26 The Department reviewed medical records from Long Beach Memorial Hospital for (R1). On 03/12/2026 The Department conducted a review of medication compliance list for (R2). On 05/01/26 The Department conducted interviews with Residents #3-10 (R3-R10) regarding the allegation above.

The investigation revealed the following:
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Lizeth Villegas
LICENSING EVALUATOR SIGNATURE:

DATE: 05/01/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/01/2026
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 2
Control Number 11-AS-20260217132633
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: 05/01/2026
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
Allegation: Staff did not provide adequate supervision, resulting in a resident in care sustaining fractures.

It is alleged that facility staff did not respond in a timely manner when a resident in care called for help. On 03/02/26 and 05/01/26 The Department conducted interviews with R1-R10 regarding the allegation above. During interview with R1, R1 confirmed being assaulted but could not provide detailed information regarding the above allegation, however, R1 believes it took 5 minutes for staff to respond and assist. Additionally, R1 states feeling safe to return to the facility for care. During interview with R2, R2 confirmed the assault however R2 did not provide any information regarding the allegation above. During interviews with R3-R10, 7 of the 8 residents interviewed denied the allegation above and reported that assistance from staff is provided when requested, 1 of the 8 residents interviewed reported being independent and assistance from staff is not required. Furthermore, 6 of the 8 residents interviewed on 05/01/26 indicated that staff response time is within minutes, 1 of the 8 residents reported staff response time can take up to an hour, 1 of the 8 residents interviewed reported being unaware as staff assistance is not required. On 03/02/26 The Department conducted interviews with S1-S3 regarding the allegation above. 3 of 3 staff interviewed denied the allegation above. Per 2 of the 3 staff interviewed, they were on shift the night of the incident and assisted as soon as they were notified of the situation. Per 3 of 3 staff interviewed, there was no history of violence between R1 and R2 nor individually with other residents in care. On 03/12/26 The Department conducted a review of medical records from Long Beach Memorial Hospital date: 2/15/2025 which indicated that R1 was admitted to Long Beach Memorial Hospital with a diagnosis of: Assault, Closed non displaced fracture of head of left radius sequela, and Closed fracture of multiple ribs of left side, initial encounter. On 03/12/2026 The Department conducted a review of medication compliance list for R2, per medication administration record R2 had been refusing to medications from 02/6/26- 02/13/26. Upon review it is unclear if the refusal of these medications during this period contributed the assault/battery that occurred between R1 and R2.

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 not provided.

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Lizeth Villegas
LICENSING EVALUATOR SIGNATURE:

DATE: 05/01/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/01/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 2