197800131-8-8-2022-11-AS-JHAD-CJERNZ-20220919131107

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197800131
Report Date: 08/08/2022
Date Signed: 08/08/2022 02:55:01 PM

Substantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/01/2022 and conducted by Evaluator Jose Calderon

COMPLAINT CONTROL NUMBER: 11-AS-20220801155053

FACILITY NAME:	CHATEAU LONG BEACH		FACILITY NUMBER:	197800131
ADMINISTRATOR:	BEATRICE ROMEO		FACILITY TYPE:	740
ADDRESS:	3100 E. ARTESIA BLVD.		TELEPHONE:	(562) 428-5371
CITY:	LONG BEACH	STATE: CA	ZIP CODE:	90805
CAPACITY:	184	CENSUS: 91	DATE:	08/08/2022
		UNANNOUNCED	TIME BEGAN:	09:45 AM
MET WITH:	ADMINISTRATOR BEATRICE ROMEO		TIME COMPLETED:	03:15 PM

ALLEGATION(S):

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Facility staff mismanaged residence medications

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Jose Calderon conducted an unannounced visit to the facility on 08/08/2022 at around 09:00 AM and was greeted by Administrator (S1). LPA Calderon spoke to S1 prior to entering the facility to conduct a risk assessment. LPA Calderon explained the purpose of this visit is to deliver the findings pertaining to the above-mentioned allegation.

Licensing Program Analyst (LPA) Jose Calderon conducted an unannounced 10 day visit on 08/08/2022 approximately around 09:00 AM. LPA Calderon initiated an investigation for the above-mentioned allegation and conducted a face-to-face interview with Administrator (S1). On 03/01/2022 LPA Calderon interviewed W1 for complaint. On 08/08/2022 LPA Calderon requested copies of the following: Staff and Resident rosters, admission agreement, Needs and Service Plan, Physician Report, MAR, records for W1 and MAR for R2-R5. On 08/08/2022 LPA Calderon reviewed medical records for W1, R2-R4. On 08/08/2022 LPA Calderon interview R2-R10 for complaint. On 08/08/2022 LPA Calderon interviewed S2 – S5 for complaint. On 08/08/2022 LPA Calderon reviewed medical records for W1.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Jose Calderon	TELEPHONE: (323) 213-1153
LICENSING EVALUATOR SIGNATURE:	DATE: 08/08/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/08/2022

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-20220801155053

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: CHATEAU LONG BEACH	FACILITY NUMBER: 197800131
	VISIT DATE: 08/08/2022

NARRATIVE

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Regarding Allegation #1: Facility staff mismanaged residents’ medications. On 08/08/2022 LPA Calderon interviewed W1 who states that staff have many times run out of W1 insulin and many times W1 has witness staff use W1 insulin for another resident or take medication from another resident and give that medication to W1. W1 states that this is the first time W1 filed a complaint as staff does this all the time. On 08/08/2022 LPA Calderon interviewed S1-S5, S1, S3, S4 have no information regarding the mismanagement of W1 medications. S2, S3 state that W1 type 75 insulin had run out and W1 went 3 days without taking type 75 insulin shot. S2-S3 state that no staff ever shares medication from one resident supply with another resident and has never used needles from another resident supply for use by another resident living in the facility. On 08/08/2022 LPA Calderon interviewed R2-R10 all state to be happy with services provided by staff and staff have never run out of their medication and have never used another medication supply for other residents use. On 08/08/2022 LPA Calderon reviewed Physician Report, Needs and Service plan and MAR for July and August for W1, reports state that W1 has diabetes and take type 75 insulin. Reviewed MAR for R2-R4, no issues or concerns noted.

Based on LPA Calderon observations and interviews which were conducted and the records that were reviewed, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division 6 are being cited on the attached LIC 9099D.

An exit interview was conducted and copy of the Complaint Report and Appeal Rights were provided to the Administrator (S1).

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Jose Calderon	TELEPHONE: (323) 213-1153
LICENSING EVALUATOR SIGNATURE:	DATE: 08/08/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/08/2022

LIC9099 (FAS) - (06/04)

Page: 3 of 3

Control Number 11-AS-20220801155053

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: CHATEAU LONG BEACH	FACILITY NUMBER: 197800131
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 08/08/2022

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 08/19/2022 Section Cited CCR 87465(a)(4)	1 2 3 4 5 6 7	87465 Incidental Medical and Dental Care. A: A plan for incidental medical and dental care shall be developed by each facility. 4: The licensee shall assist residents with self-administered medications as needed.. This requirement is not met as evidenced by:	1 2 3 4 5 6 7	Faciity administrator will provide training to staff regarding the odering of medication for residents and the proper documenation and record keeping for facility by the POC date to LPA Calderon.
	8 9 10 11 12 13 14	Based on observations and interviews LPA Calderon confirmed that the facility ran out of type 75 insulin for witness 1 for 3 daya. This poses a potential health & 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.

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Jose Calderon	TELEPHONE: (323) 213-1153
LICENSING EVALUATOR SIGNATURE:	DATE: 08/08/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/08/2022

LIC9099 (FAS) - (06/04)

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