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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197608029
Report Date: 09/01/2026
Date Signed: 09/01/2026 03:56:01 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
08/24/2026 and conducted by Evaluator Felisa Shirley
COMPLAINT CONTROL NUMBER: 11-AS-20260824102815
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: 238DATE:
09/01/2026
UNANNOUNCEDTIME BEGAN:
08:59 AM
MET WITH:TIME COMPLETED:
04:00 PM
ALLEGATION(S):
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Resident became malnourished and dehydrated due to staff neglect while in care
Staff did not ensure resident's hygiene needs were met while in care
Staff did not prevent resident from being bitten by bed bugs while in care
INVESTIGATION FINDINGS:
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On 9/1/26, 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 9/1/26 LPA Felisa Shirley reviewed copies of the following records: Staff and Resident Roster, face sheet, Identification and Emergency Information, Physician’s Report, Service plan, Physicians Orders, Hospitalization list, and service schedules. LPA Shirley conducted a tour of the facility. LPA Shirley interviewed Staff 1 – Staff 8 (S1 – S8), and Resident 2 – Resident 7 (R2-R7). LPA attempted to talk to R1 three times.

Con'd on 9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Felisa Shirley
LICENSING EVALUATOR SIGNATURE:

DATE: 09/01/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/01/2026
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 3
Control Number 11-AS-20260824102815
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: 09/01/2026
NARRATIVE
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The investigation revealed the following:

Allegation: Resident became malnourished and dehydrated due to staff neglect while in care.

It is being alleged that R1 has been in the hospital due to being malnourished and dehydrated. LPA Felisa Shirley reviewed an incident report dated 7/30/26, which informed Community Care Licensing that R1 had an unwitnessed fall and was laying supine on the floor and couldn’t remember how they got on the floor. Staff called 911 and notified R1’s family and was then transported to Long Beach Memorial for treatment and has not returned back to the facility. During file review on 9/1/26, LPA Shirley observed that R1 has been diagnosed with dementia per physician’s report dated, 4/9/25. Per the physician’s orders dated 10/17/25, R1 was prescribed Metformin CL ER 500 mg on 3/15/25 which causes mild weight reduction over time.

LPA interviewed staff 1 – staff 8 (S1 – S8). Of those interviewed 8 out of 8 denied the allegation. LPA interviewed resident 2 – resident 7 (R2 – R7). Of those who interviewed 6 out of 6 denied the allegation.

Based on information gathered, LPA did not find sufficient evidence to support the allegation “Resident became malnourished and dehydrated due to staff neglect while in care,” therefore, the allegation is unsubstantiated.

Allegation: Staff did not ensure resident's hygiene needs were met while in care.

It is being alleged that R1’s fingernails were long and dirty and that R1 had not been shaved. On 9/1/26, LPA Shirley observed the Services Schedule for the residents which included grooming for residents in Assisted Living. LPA Shirley inquired as to why there was no schedule for servicing for the residents in Memory Care; S1 stated that the residents in Memory care are all on total care/assistance constantly and no schedule was needed. During interviews on 9/1/26, S1 stated that the facility does offer light grooming. S1 also stated that there is a licensed beautician that services residents upon request. During LPA Shirley’s interviews with R4, R5 and R6 on 9/1/26, LPA Shirley observed that their fingernails were clean.

LPA interviewed staff 1 – staff 8 (S1 – S8). Of those interviewed 8 out of 8 denied the allegation. LPA interviewed resident 2 – resident 7(R2 – R7). Of those who interviewed 6 out of 6 denied the allegation.

Based on information gathered, LPA did not find sufficient evidence to support the allegation “Staff did not ensure resident's hygiene needs were met while in care,” therefore, the allegation is unsubstantiated.

Con'd on 9099-C

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Felisa Shirley
LICENSING EVALUATOR SIGNATURE:

DATE: 09/01/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/01/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 11-AS-20260824102815
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: 09/01/2026
NARRATIVE
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Allegation: Staff did not prevent resident from being bitten by bed bugs while in care

It is being alleged that R1 had scars and bite marks due to a bed bug infestation. Due to a review of incident reports on 9/1/26, LPA Felisa Shirley did not observe any incident reports indicating that Vista Del Mar has experienced a bed bug infestation. On 9/1/26, LPA Shirley interviewed S8, the Maintenance Director who stated that there have been no reports or complaints of bed bugs at this facility. LPA Shirley interviewed S1 – S8 and R2 – R7 on 9/1/26, all of whom stated that they have not observed or experienced any bed bugs at this facility.

LPA interviewed staff 1 – staff 5 (S1 – S5). Of those interviewed 8 out of 8 denied the allegation. LPA interviewed resident 2 – resident 7 (R2 – R7). Of those who interviewed 5 out of 6 denied the allegation, and 1 confirmed it.

Based on information gathered, LPA did not find sufficient evidence to support the allegation “Staff did not prevent resident from being bitten by bed bugs while in care,” 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: 09/01/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/01/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 3