197800131-11-3-2022-11-AS-UCOL-CLR25J-20221202160539

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197800131
Report Date: 11/03/2022
Date Signed: 11/03/2022 04:32:00 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO, 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
10/28/2022 and conducted by Evaluator Don Senaha

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20221028154641

FACILITY NAME:	CHATEAU LONG BEACH		FACILITY NUMBER:	197800131
ADMINISTRATOR:	KHATERA BAHADORY		FACILITY TYPE:	740
ADDRESS:	3100 E. ARTESIA BLVD.		TELEPHONE:	(562) 428-5371
CITY:	LONG BEACH	STATE: CA	ZIP CODE:	90805
CAPACITY:	184	CENSUS: 93	DATE:	11/03/2022
		UNANNOUNCED	TIME BEGAN:	09:23 AM
MET WITH:	Khatera Bahadory/Administrator		TIME COMPLETED:	04:30 PM

ALLEGATION(S):

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Staff do not respond in a timely manner to resident’s calls for assistance.
Staff served resident spoiled food.
Staff are not serving resident food that is nutritious.
Staff are not providing updated menus for residents to preview.

INVESTIGATION FINDINGS:

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On 11/03/2022 Licensing Program Analyst (LPA) Don Senaha initiated a complaint investigation for the allegations listed above. Today’s complaint investigation was conducted with Administrator Khatera Bahadory.

The investigation consisted of the following: LPA requested resident roster, staff roster and other service documents. LPA interviewed Residents (R1-R10) and Staff (S1-S5). A plant inspection of the facility was conducted.

There were no deficiencies found during the visits.

Investigation revealed:

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Ulysses Coronel	TELEPHONE: (323) 400-7397
LICENSING EVALUATOR NAME: Don Senaha	TELEPHONE: (323) 629-5133
LICENSING EVALUATOR SIGNATURE:	DATE: 11/03/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/03/2022

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-20221028154641

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: CHATEAU LONG BEACH	FACILITY NUMBER: 197800131
	VISIT DATE: 11/03/2022

NARRATIVE

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Allegation: Staff do not respond in a timely manner to resident’s calls for assistance.

During the course of investigation, LPA was unable to find any evidence supporting the allegation.

Residents (R1-R10) stated the residents are to pull the chord for assistance. 7 of 10 residents stated staff does respond to the call for assistance in a timely manner. Resident (R2) stated resident has never pulled the chord for assistance. Staff (S1, S3, S4) stated residents use the pull chord in the bedroom or bathroom to call for assistance. Staff (S1, S3, S4) stated it may take from 2 minutes to 5 minutes to get assistance. Staff (S1, S3, S4) stated the caregivers do make rounds every 2 hours to check on residents. LPA observed the pull chord for assistance to be in working order when touring the facility. LPA did not observe any incident reports for staff not responding in a timely manner to resident’s calls for assistance.

Based on the interviews conducted, observation and records review, LPA was unable to find evidence to support the allegation.

Allegation: Staff served resident spoiled food.

During the course of the investigation, LPA was unable to find any evidence supporting the allegation.

Residents (R1-R10) stated they have not been served spoiled foods for breakfast, lunch, dinner or snacks. Staff (S1-S5) stated staff have no concerns or issues with residents reporting spoiled foods being served for breakfast, lunch, dinner or snacks. Staff (S2, S5) stated the staff rotates the stock of food upon delivery. LPA observed unexpired foods in the pantry, freezer and walk in refrigerator. LPA observed food service in the dining area at lunch to be fresh. LPA confirmed with Staff (S2, S5) the soup of the day may include meats or vegetables from lunch but no spoiled foods.

Based on the interviews conducted, observation and records review, LPA was unable to find evidence to support the allegation.

SUPERVISOR'S NAME: Ulysses Coronel	TELEPHONE: (323) 400-7397
LICENSING EVALUATOR NAME: Don Senaha	TELEPHONE: (323) 629-5133
LICENSING EVALUATOR SIGNATURE:	DATE: 11/03/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/03/2022

LIC9099 (FAS) - (06/04)

Page: 4 of 4

Control Number 11-AS-20221028154641

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: CHATEAU LONG BEACH	FACILITY NUMBER: 197800131
	VISIT DATE: 11/03/2022

NARRATIVE

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Allegation: Staff are not serving resident food that is nutritious.

During the course of investigation, LPA was unable to find any evidence supporting the allegation.

Residents (R1-R10) stated they receive breakfast, lunch, dinner and snacks. 9 of 10 residents did not have any concerns or issues with the food being served. Staff (S1) stated the facility has a hired nutritionist. Staff (S1, S2, S5) stated staff will follow any nutritious facts regarding special diets. Staff (S1, S2, S5) serves the residents with special diets the proper foods and ensures food choices through the alternate menu or the “sugar free items” list. LPA observed and obtained menu to include variety of foods. LPA observed and obtained a meal entrée alternate policy for lunch and dinner. LPA observed and obtained sugar free items available for residents with a denotation “if your physician diet order indicates, please notify the front office if you would like any of these sugar free items in place of regular items for meals”. LPA observed and obtained a copy of meal and snack portion sizes. LPA obtained the contract of the nutritionist who serves the facility.

Based on the interviews conducted, observation and records review, LPA was unable to find evidence to support the allegation.

Allegation: Staff are not providing updated menus for residents to preview.

During the course of the investigation, LPA was unable to find any evidence supporting the allegation.

Residents (R1-R10) did not have any concerns with the updated menu being posted. Residents (R1-R3, R5–R10) stated the menu is posted on the wall near the dining area. Resident (R4) stated staff lets him know before he eats what is being served on the menu due to medical condition. Staff (S1-S5) stated menu is located on the bulletin board and shows weekly and daily meals served. LPA observed weekly menu posted on the board outside the dining hall. LPA observed daily menu for breakfast, lunch and dinner posted on the board outside the dining hall. LPA observed “special order” option for residents to fill out should residents want another option than what is being served. LPA received copies of the menus and postings.

Based on the interviews conducted, observation and records review, LPA was unable to find evidence to support the allegation.

SUPERVISOR'S NAME: Ulysses Coronel	TELEPHONE: (323) 400-7397
LICENSING EVALUATOR NAME: Don Senaha	TELEPHONE: (323) 629-5133
LICENSING EVALUATOR SIGNATURE:	DATE: 11/03/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/03/2022

LIC9099 (FAS) - (06/04)

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Control Number 11-AS-20221028154641

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: CHATEAU LONG BEACH	FACILITY NUMBER: 197800131
	VISIT DATE: 11/03/2022

NARRATIVE

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Based on the interviews conducted, observation and records review, LPA was unable to find evidence to support the allegations. Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are Unsubstantiated.

An exit interview was conducted with Administrator Khatera Bahadory and a hard copy was provided.

SUPERVISOR'S NAME: Ulysses Coronel	TELEPHONE: (323) 400-7397
LICENSING EVALUATOR NAME: Don Senaha	TELEPHONE: (323) 629-5133
LICENSING EVALUATOR SIGNATURE:	DATE: 11/03/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/03/2022

LIC9099 (FAS) - (06/04)

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