197800131-1-10-2024-11-AS-MVAO-CZCTA6-20240110133301

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197800131
Report Date: 08/25/2023
Date Signed: 01/10/2024 08:52:12 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 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
03/08/2023 and conducted by Evaluator Pamela Bunker

COMPLAINT CONTROL NUMBER: 11-AS-20230308125913

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: 102	DATE:	08/25/2023
		UNANNOUNCED	TIME BEGAN:	09:55 AM
MET WITH:	Administrator Khatera Bahadory.		TIME COMPLETED:	02:15 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff are not notifying resident's representative of unusual incidents
Staff would not allow resident to have telephone call
Staff mismanaged resident's vitamins

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst (LPA) Pamela Bunker conducted an unannounced complaint visit on Friday, August 25, 2023, Upon arrival at the facility. LPA Bunker called the facility via telephone and conducted a Risk Assessment. Based on the assessment, the facility is cleared of COVID-19 infection. LPA Bunker met with Administrator Khatera Bahadory. LPA Bunker explained the purpose of today's visit.
The investigation consisted of the following: During the investigation on 03/17/2023 interviews were conducted with staff 1-2 (S1-S2) and resident 1 (R1). On 08/25/2023 LPA Bunker interviewed staff 1-2 (S1-S2) and residents 2-6 (R2-R6). LPA Bunker asked questions relevant to the nature of the complaint. Resident 1 (R1) records were requested and reviewed. S1-S2 stated staff notified the resident's family of all unusual incidents. S1-S2 stated that R1 does not have a medical or financial Power of Attorney (POA) representative. S1-S2 stated that R1 has a cellphone and is allowed telephone calls. S1-S2 stated Department of Public Health shut the facility down due to the COVID-19 outbreak. During that time no visitors were allowed. S1-S2 stated the facility was back to normal and cleared of COVID-19-positive cases on Tuesday, 03/14/2023. S1-S2 stated that R1 medication was not mismanaged. See LIC9099-C page 2.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Stephanie Cifuentes	TELEPHONE: (661) 644-7743
LICENSING EVALUATOR NAME: Pamela Bunker	TELEPHONE: (323) 213-1113
LICENSING EVALUATOR SIGNATURE:	DATE: 08/25/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/25/2023

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-20230308125913

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: CHATEAU LONG BEACH	FACILITY NUMBER: 197800131
	VISIT DATE: 08/25/2023

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

Continued LIC9099-C page 2

**Allegation #1:** Staff are not notifying the residents' representatives of unusual incidents.
Staff 1-2 (S1-S2) and residents 1-6 (R1-R6) interviewed stated that the facility staff do notify residents' families and representatives of unusual incidents. S1-S2 reported that R1's family was notified when R1 fell while going outside to smoke a cigarette and was subsequently taken to the hospital. S1-S2 also stated that R1's family was immediately informed when R1 fell and tested positive for COVID-19, leading to R1 being quarantined for 10 days. S1-S2 mentioned that R1 does not have a medical or financial Power of Attorney (POA) representative. Both S1-S2 and R1-R6 denied the allegation.

**Allegation #2:** Staff would not allow the resident to have a telephone call.
Staff 1-2 (S1-S2) and residents 1-6 (R1-R6) interviewed stated that staff do allow residents to have telephone calls. S1-S2 noted that R1 has a personal cellphone and can make and receive calls freely. S1-S2 confirmed that residents are permitted to receive telephone calls and that R1 can talk to her family at any time. Despite R1 being quarantined for 10 days due to a positive COVID-19 test, and the facility being shut down by the Public Health Department during a COVID-19 outbreak, S1-S2 clarified that this did not prevent R1 from receiving and making telephone calls. Both S1-S2 and R1-R6 denied the allegation.

**Allegation #3:** Staff mismanaged residents' vitamins.
Staff 1-2 (S1-S2) and residents 1-6 (R1-R6) reported that the staff do not mismanage residents' medications. S1-S2 and R1-R6 indicated that staff dispense medications according to the physicians' orders. S1-S2 specified that R1 is prescribed vitamin B-1 100 MG tablets, not B12, as per R1's doctor's orders. R1 takes one B-1 tablet orally once daily. S1-S2 affirmed that R1 does not take B12 vitamins. Both S1-S2 and R1-R6 denied the allegation.

The investigation consisted of the following: In response to the COVID-19 pandemic outbreak, the Public Health Department mandated the temporary closure of the facility, prohibiting visitor access until clearance was obtained from the department. Staff members S1-S2 confirmed that during this period, all necessary medications for Resident 1 (R1) were administered in accordance with medical directives.

See continued LIC9099-C page 3

SUPERVISOR'S NAME: Stephanie Cifuentes	TELEPHONE: (661) 644-7743
LICENSING EVALUATOR NAME: Pamela Bunker	TELEPHONE: (323) 213-1113
LICENSING EVALUATOR SIGNATURE:	DATE: 08/25/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/25/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 11-AS-20230308125913

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: CHATEAU LONG BEACH	FACILITY NUMBER: 197800131
	VISIT DATE: 08/25/2023

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

Continued LIC9099-C page 3

Furthermore, they affirmed that the facility consistently adheres to proper medication management protocols for all residents (R1-R6), ensuring no mismanagement occurs.
Staff members S1-S2 specifically noted that R1's medications, including Vitamin B-1 (not B12), were dispensed as per the physician's orders. They also stated that the facility makes it a priority to notify representatives of any unusual incidents involving residents, in line with Title 22 Regulations. This includes reporting all special incidents to relevant agencies promptly.
Regarding Resident 1's communication rights, it was stated by S1-S2 that R1, who does not have a medical or financial Power of Attorney (POA) representative, is permitted to make telephone calls and possesses a personal cellphone. Although R1's room lacks a personal telephone, access to the facility's public phone is available, with house rules #17 stipulating its availability to residents from 9:00 A.M. to 5:00 P.M., and for emergencies or special cases outside these hours. Moreover, it was noted that some residents have free cell phones, enabling them to make and receive calls independently.
The facility's policy on managing residents' financial matters was clarified by S1-S2. They stated that R1 and her family members directly handle R1's bill payments, as outlined in the admission agreement (referenced on page 6). This approach also applies to services provided by external vendors, where payment agreements are solely between the resident and the vendor. The facility's stance remains neutral in these financial arrangements, including those with the resident pharmacy, which operates as a third party and deals directly with residents on individual terms.
On the matter of medication supplies, staff members S1-S2 mentioned that the facility does not purchase vitamins for residents. They provided specific instances, noting that on 02/26/2023, the pharmacy sent B12 vitamins, and clarified that there was no indication of a shortage of B12 vitamins for Resident 1 as of 03/02/2023. The facility's protocol includes notifying residents and their responsible parties in the event of medication running low, or requiring a refill. S1-S2 and R1-R6 denied the allegation.

Based on interviews, available evidence, observation, information received, and records reviewed there was not enough sufficient evidence to support the allegation. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is deemed unsubstantiated.
A copy of the Complaint Investigation Report LIC9099 and LIC9099-C provided to the facility Administrator Khatera Bahadory. There were no deficiencies cited. An exit interview was conducted.

SUPERVISOR'S NAME: Stephanie Cifuentes	TELEPHONE: (661) 644-7743
LICENSING EVALUATOR NAME: Pamela Bunker	TELEPHONE: (323) 213-1113
LICENSING EVALUATOR SIGNATURE:	DATE: 08/25/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/25/2023

LIC9099 (FAS) - (06/04)

Page: 3 of 3