197608029-9-30-2026-11-AS-PMAA-DYWRB4-20261016125206

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197608029
Report Date: 09/30/2026
Date Signed: 09/30/2026 03:41:18 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
07/06/2026 and conducted by Evaluator Lizeth Villegas

COMPLAINT CONTROL NUMBER: 11-AS-20260706083658

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: 240	DATE:	09/30/2026
		UNANNOUNCED	TIME BEGAN:	09:17 AM
MET WITH:	Suzette Johnson		TIME COMPLETED:	03:49 PM

ALLEGATION(S):

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Staff do not ensure drinking water is clean and sanitary.
Staff do not prevent resident from unsafely operating motorized wheelchair.
Staff did not ensure resident's privacy is protected.
Staff do not ensure residents are provided with a safe and comfortable environment.

INVESTIGATION FINDINGS:

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On 09/30/26 The Department conducted a subsequent complaint visit regarding the allegation(s) above. LPA met with Suzette Johnson (staff #1/S1) as the purpose of today’s visit was explained.

The investigation consisted of the following: On 09/21/26 The Department obtained copies of the staff and resident roster, and copies of the following for Resident #2 (R2) Emergency ID form, Physicians report dated:07/08/26, Service plan dated: 03/12/26, and facility notes for (R1) dated: May 2026-July 2025. On 07/07/26 LPA Leandro obtained the following for Resident #1 (R1): Admission agreement dated: 01/17/25, service plan dated: 03/12/26, Medication administration records (MAR) for March 2026 to August 2026, and physicians report dated: 06/16/2026. On 09/21/26 The Department

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Lizeth Villegas
LICENSING EVALUATOR SIGNATURE:	DATE: 09/30/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/30/2026

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-20260706083658

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: 09/30/2026

NARRATIVE

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conducted a tour of the facility and conducted interviews with Residents #1-10 (R1-R10). On 09/21/26 and 09/30/26 The Department conducted interviews with Staff #1-5 (S1-S5).

The investigation revealed the following:

Allegation: Staff do not ensure drinking water is clean and sanitary.

It is alleged that there is a resident in care who digs through the ice with their dirty hands" and none of the staff say anything. On 09/21/26 The Department conducted a tour of the facility and conducted interviews with R1-R10 regarding the allegation above. 7 of the 10 residents interviewed denied the allegation above. 2 of the 10 residents interviewed confirmed the allegation above, however only 1 of the 2 residents that confirmed the allegation above stated that they reported it to staff. 1 of the 10 residents interviewed confirmed the allegation above but stated that it was a long time ago and could not remember what resident did it. On 09/21/26 LPA conducted a tour of the facility and observed the water stations on each floor; LPA observed the water tank to be sealed and cannot be easily opened. On 09/21/26 and 09/30/26 The Department conducted interviews with S1-S5. 5 of 5 staff interviewed denied the allegation above and stated that if this allegation was observed they would report it and have the water changed right away.

Allegation: Staff do not prevent a resident from un-safely operating motorized wheelchair.

It is alleged that a resident in care uses an electric wheelchair and runs into peers with it. On 09/21/26 The Department conducted interviews with R1-R10 regarding the allegation above. 7 of the 10 residents interviewed denied the allegation above. 2 of the 10 residents interviewed confirmed the allegation above and stated that they have reported it to staff, and staff have asked the resident to be careful. 1 of the 10 residents interviewed confirmed the allegation above but stated they are not sure if it was done purposely or not. On 09/21/26 and 09/30/26 The Department conducted interviews with S1-S5. 5 of 5 staff interviewed denied the allegation above, and stated that although this has occurred

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Lizeth Villegas
LICENSING EVALUATOR SIGNATURE:	DATE: 09/30/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/30/2026

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 11-AS-20260706083658

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: 09/30/2026

NARRATIVE

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they do not believe it was done on purpose or to cause harm. Staff state residents attempt to enter common spaces all at once and that is when a resident can get pushed or shoved on accident. On 09/30/26 The Department conducted a review of facility notes and observed that there was a documented incident between R1 and R2 on 07/05/26. Per facility notes, R1 became upset that R2 was unable to control scooter and R2 almost bumping into other residents entering the dining room. Facility staff had to stand between both residents in order to de-escalate the situation, R2 later approached staff and stated R2 waned to apologize to peers.

Allegation: Staff did not ensure resident's privacy is protected.

It is being alleged that staff do not ensure residents’ privacy is protected. On 09/21/26 Department conducted interviews with R1-R10 regarding the allegation above. 10 of 10 residents interviewed denied the allegation above. On 09/21/26 and 09/30/26 The Department conducted interviews with S1-S5. 5 of 5 staff interviewed denied the allegation above.

Allegation: Staff do not ensure residents are provided with a safe and comfortable environment.

It is being alleged that staff apply lotion on a resident’s back in the dining room while other residents are having their meals. On 09/21/26 The Department conducted interviews with R1-R10 regarding the allegation above. 9 of the 10 residents interviewed denied the above allegation. 1 of the 10 residents interviewed confirmed the above allegation and stated that it is actively going on. Additionally, 1 of the 10 residents stated they have not reported this incident to management. On 09/21/26 and 09/30/26 The Department conducted interviews with S1-S5. 5 of 5 staff interviewed denied the allegation above. 4 of the 5 staff stated that topical medications are administered in the residents bedrooms. On 09/30/26 The Department conducted a review of Mediation administration record (MAR) for R2, LPA observed that R2 has (2) prescribed lotions that are PRNs (as needed) and not administered daily.

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: 09/30/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/30/2026

LIC9099 (FAS) - (06/04)

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