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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197800131
Report Date: 04/15/2024
Date Signed: 05/01/2024 09:18:09 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
04/08/2024 and conducted by Evaluator Regina Cloyd
COMPLAINT CONTROL NUMBER: 11-AS-20240408000759
FACILITY NAME:CHATEAU LONG BEACHFACILITY NUMBER:
197800131
ADMINISTRATOR:KHATERA BAHADORYFACILITY TYPE:
740
ADDRESS:3100 E. ARTESIA BLVD.TELEPHONE:
(562) 428-5371
CITY:LONG BEACHSTATE: CAZIP CODE:
90805
CAPACITY:184CENSUS: 81DATE:
04/15/2024
UNANNOUNCEDTIME BEGAN:
09:10 AM
MET WITH:Administrator Khatera BahadoryTIME COMPLETED:
10:00 AM
ALLEGATION(S):
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9
Staff did not properly safeguard the facility grounds.
Staff did not properly safeguard a resident's personal belongings.
Staff are not preventing an unauthorized individual access to the facility.
INVESTIGATION FINDINGS:
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The purpose of the amendment is to provide additional information and it does not change the investigation findings. On 04/15/2024 Licensing Program Analyst (LPA) Regina Cloyd conducted a subsequent complaint visit at the above mentioned facility. LPA was met by Administrator Khatera Bahadory and the purpose of the visit is to deliver the findings from the previous visit. On 04/10/2024 Licensing Program Analyst (LPA) Regina Cloyd conducted a complaint investigation at the above facility to address the following allegation(s). LPA met with Administrator Khatera Bahadory and Assistant Administrator Jennifer Rivas and explained the purpose of the visit. The investigation consisted of the following: During today’s investigation, LPA toured the facility, conducted record review, and interviewed 8 residents and 9 staff members.

Continue to LIC9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Ulysses CoronelTELEPHONE: (323) -40-7397
LICENSING EVALUATOR NAME: Regina CloydTELEPHONE: 323-981-7155
LICENSING EVALUATOR SIGNATURE:

DATE: 05/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/01/2024
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-20240408000759
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: 04/15/2024
NARRATIVE
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Allegation(s):
Staff did not properly safeguard the facility grounds.
Staff are not preventing an unauthorized individual access to the facility.

The investigation revealed the following: Regarding the allegation "Staff did not properly safeguard the facility grounds and Staff are not preventing an unauthorized individual access to the facility,” it is being alleged that a former resident snuck onto the property and stole a resident’s clothes. Interviews conducted indicate the following: the (2) facility entry doors and parking lot gate are secured and monitored by video surveillance and the facility utilizes a Call Light system. LPA observed an alarm device on the main entry gate and the pathways lead to the office and dining hall. Interviews indicated that the alarm device comes on once the first floor office staff departs around 7:00 PM. LPA observed video surveillance cameras monitoring the dining hall and office entryway. LPA observed video surveillance desk monitors in the main office on the first floor and in the Medtech room on the second floor. Interviews indicated that the Receptionist and night staff (Medtechs and Caregivers) utilize the Call Light system that alerts staff of opened doors. The second entry gate is also monitored by cameras. Based on the interviews and observations, the Department found no evidence to support the allegation mentioned above. 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, as a result, the allegation is Unsubstantiated.

Allegation(s):
Staff did not properly safeguard a resident's personal belongings.
Staff are not preventing an unauthorized individual access to the facility.

The investigation revealed the following: Regarding the allegations, "Staff did not properly safeguard a resident's personal belongings and Staff are not preventing an unauthorized individual access to the facility,” it is being alleged that a former resident been given keys to the facility to access other resident's rooms. Interviews conducted indicate the following: the former resident moved away from the facility six month ago keys are only issued at the time of move-in and reissued when lost, residents can lock their doors, and the rooms contain lockboxes to safeguard additional items. During the facility tour. LPA observed some locked and unlocked bedroom doors on the second floor and lockboxes in the rooms.

Continue to LIC9099-C
SUPERVISOR'S NAME: Ulysses CoronelTELEPHONE: (323) -40-7397
LICENSING EVALUATOR NAME: Regina CloydTELEPHONE: 323-981-7155
LICENSING EVALUATOR SIGNATURE:

DATE: 05/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/01/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 11-AS-20240408000759
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: 04/15/2024
NARRATIVE
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Record review indicates that the facility tracks lost keys and inventories a resident’s personal property. R1 stated that R1 declined to have Rl’s personal items inventoried at admissions. Based on the interviews observations, and record reviews, the Department found no evidence to support the allegation mentioned above- 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, as a result, the allegation is Unsubstantiated.

No deficiencies were cited.

An exit interview was conducted and a copy of this report was provided to the Administrator Khatera Bahadory.

SUPERVISOR'S NAME: Ulysses CoronelTELEPHONE: (323) -40-7397
LICENSING EVALUATOR NAME: Regina CloydTELEPHONE: 323-981-7155
LICENSING EVALUATOR SIGNATURE:

DATE: 05/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/01/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 3