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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197800131
Report Date: 12/19/2024
Date Signed: 01/16/2025 09:26:11 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
10/15/2024 and conducted by Evaluator Regina Cloyd
PUBLIC
COMPLAINT CONTROL NUMBER: 11-AS-20241015132426
FACILITY NAME:CHATEAU LONG BEACHFACILITY NUMBER:
197800131
ADMINISTRATOR:JENNIFER RIVASFACILITY TYPE:
740
ADDRESS:3100 E. ARTESIA BLVD.TELEPHONE:
(562) 428-5371
CITY:LONG BEACHSTATE: CAZIP CODE:
90805
CAPACITY:184CENSUS: 90DATE:
12/19/2024
UNANNOUNCEDTIME BEGAN:
08:09 AM
MET WITH:Administrator Cindy Nicolson-BolongTIME COMPLETED:
03:10 PM
ALLEGATION(S):
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Facility staff mismanaged residents medication.
Residents are not provided adequate meals.
Staff do not provide adequate shower assistance to residents in care.
Facility administrator is not qualified.
INVESTIGATION FINDINGS:
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This amendement is to clarify the narrative on one 9099-C page and does not change the determination findings. The investigation consisted of the following:

On 10/18/24, Licensing Program Analyst (LPA) Regina Cloyd conducted a complaint investigation at the above facility to address the following allegations. LPA Cloyd spoke Administrator Cindy Nicolson-Bolong and explained the purpose of the visit. LPA Cloyd received facility records, observed lunch, and interviewed residents and staff. On 12/19/24, LPA Cloyd conducted a subsequent complaint investigation, met with Administrator and explained the purpose of the visit. During today’s visit, LPA interviewed staff and residents and reviewed facility documents.

Regarding the allegation "Staff mismanaged residents’ medication," it is being alleged that staff has given the wrong medication to several residents resulting in hospitalization. Specifically Resident #2 (R2) was given the wrong medication in September 2024. 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: 01/16/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/16/2025
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 4
Control Number 11-AS-20241015132426
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: 12/19/2024
NARRATIVE
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September and October 2024 Medication Administration Record (MAR) for R2 did not reveal medication errors. Interview with R2 indicated staff has not made medication errors. Record reviewed revealed five residents (R3 – R7) with unusual incident reports that resulted in hospitalization in September – October 2024. On 10/16/24, R3 went to the hospital due to shortness of breath. Interview with Wellness Director indicated R3 takes three medications for diagnosis and an inhaler. October MAR revealed that R3 took the three medications daily and had access to R3’s inhaler from 10/01/14 – 10/15/24. Interview with R3 indicated there hasn’t been any medication errors and hospitalization was not caused by medication errors. R4 and R5 MAR’s did not reveal medication errors. R6 went to the hospital for primary diagnosis and MAR revealed R6 took medication prior to hospitalization. R6 was unavailable for interview. R7 went to the hospital for diagnosis. Interview with Wellness Director indicated that R7’s medication list is reconciled by the Nurse after every hospitalization. Interview with R7 indicated staff have not made medication errors and hospitalization was not caused by medication errors. Five out of seven staff interviews indicated there were no medication errors in September and October 2024. One staff member was unsure. Six out of ten residents indicated there were no medication errors in September and October 2024.

Regarding the allegation “Staff mismanaged residents’ medication," based on record reviews and interviews, 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 deficiency was cited for this allegation.

Allegation:
Regarding the allegation "Residents are not provided adequate meals," it is being alleged that the facility does not provide fresh food and recycles previous meals from the week to make a different dish. Also, it is being alleged that the facility only provides half portion of the meals and it constantly cause diarrhea. Record review revealed fruit and vegetables are available upon request for morning and afternoon snack, vegetables and occasionally fruit are served for lunch, and vegetables and soup of the day are included at dinner. Three staff interviews clarified that unserved ingredients from lunch are used in the soup at dinner time. One of the three staff members (S5) have a food handler certificate valid from 04/16/24 to 04/16/27. Six staff interviews indicated there has not been an increase of diarrhea at the facility. Week 6 menu revealed Sunday’s lunch included baby back ribs, mac & cheese, baked beans, sliced pears, and assorted beverages. Continue to LIC9099-C.

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

DATE: 01/16/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/16/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 11-AS-20241015132426
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: 12/19/2024
NARRATIVE
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Sunday’s dinner included soup of the day, cold cut sandwich with lettuce and tomato, corn chips, tapioca pudding, and assorted beverages. Interview with S2 indicated that the menus (week 1 – week 6) rotate every six weeks. Interview with the Administrator (S1) indicated that the former Head Cook gave larger portions. Since then, the facility has chefs from other facilities who has been strict with serving sizes and the topic has been discussed with the residents. However, the kitchen will provide additional food items if available. Interview with the Director of Operations (S2) indicated that the Licensee has a standardized menu created by a Consultant Dietician, seconds are available to residents, and the facility make sure residents receive their 2000 calories. Record review revealed residents can receive up to (per weekday) 8 oz of protein, 2 servings and ½ cup of fruit, 4 servings and ½ cup of vegetables, 4 servings of carbohydrates, and desserts and bacon/sausage are based on discretionary calories. Seven out of ten staff interviews indicated adequate meals are served to the residents. Two out of ten staff interviews indicated residents have complained about the portion sizes. One staff was unaware if adequate meals were served. Nine out of nine resident interviews indicated that the food quantity is good. Six out of seven resident interviews indicated not experiencing diarrhea. LPA observed residents eating lunch. Two residents said the facility will provide seconds if there is enough food. One resident interjected and said they never make enough food. Resident stated the change in quantity is because they have new cooks.

Regarding the allegation “Residents are not provided adequate meals," based on record reviews, 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.

No deficiency was cited for this allegation.

Allegation:
Regarding the allegation "Staff do not provide adequate shower assistance to residents in care," it is being alleged that staff have cut down on showering residents and/or do not shower residents due to having two caregivers work each shift. Record review revealed that 28 out of 90 residents need assistance with showers. Shower assistance is provided in the morning and in the evening amongst the two caregivers on shift. Record review revealed there are at least two caregivers and one MedTech working per shift. The three Department Supervisors work at least five days per week (mainly weekdays). Six out of seven staff interviews indicated there are at least two caregivers working per shift. Interview with the Wellness Coordinator and Wellness Director indicated that residents receive at least two showers per week depending on their incontinence needs. Continue to LIC9099-C.

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

DATE: 12/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 11-AS-20241015132426
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: 12/19/2024
NARRATIVE
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Four out of nine resident interviews indicate there are 1 – 2 caregivers per shift. Four out of nine resident interviews indicated 3-6 staff members per shift. One out of nine resident interviews indicated he/she was unsure about the number of staff members per shift. Two out of eight resident interviews indicated they receive at least two showers per week. One out of eight resident interviews indicated they get at least one shower per week. Five out of eight residents indicated they did not need showering assistance. Regarding the allegation “Staff do not provide adequate shower assistance to residents in care," based on record reviews and interviews, 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 deficiency was cited for this allegation.

Allegation:
Regarding the allegation "Facility administrator is not qualified," it is being alleged that the Staff #11 (S11) is not certified to act as the Administrator. Personnel Report revealed that S11 works as the Business Manager and has been employed since 04/23/2018. Interview with S11 indicated that S11 predominantly provides assistance with the business. The facility’s former Administrator departed on 08/06/24. The current Assistant Administrator (S12) was designated responsible on 08/06/24 and was supported by the Regional Director (S2). Record review revealed S2’s RCFE Certification expired on 08/26/24 and S2 is on the Administrator Certification Bureau (ACB) RCFE certification renewal list as of 07/05/2024. S12 has an active RCFE certification from 02/23/2024 – 02/23/2026. S2 and S12 both have at least two years of college and three years of RCFE experience. The Current Administrator (S1) was hired as Administrator on 08/11/2024, completed training, and started in the facility on 09/10/24. Interview with S1 and S12 indicated S11 did not serve as the acting administrator.

Regarding the allegation “Facility administrator is not qualified," based on record reviews and interviews, 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 deficiency was cited for this allegation.

An exit interview was conducted and a copy of this report was reviewed and provided to the Administrator Cindy Nicolson-Bolong.

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

DATE: 12/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/19/2024
LIC9099 (FAS) - (06/04)
Page: 4 of 4