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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197800131
Report Date: 03/06/2025
Date Signed: 03/06/2025 01:11:21 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/03/2024 and conducted by Evaluator Lizeth Villegas
COMPLAINT CONTROL NUMBER: 11-AS-20240603132824
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: 91DATE:
03/06/2025
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Assistant Administrator Jennifer Rivas TIME COMPLETED:
01:30 PM
ALLEGATION(S):
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Facility did not issue a refund to a resident in care.
INVESTIGATION FINDINGS:
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THIS REPORT SUPERSEDS REPORT DATED 6/12/24 TO ADD ADDITIONAL INFORMATION AND CHANGE INVESIGATION FINDINGS.

On 03/06/25 at 10:00 am licensing program analyst (LPA) Villegas conducted a subsequent visit to deliver complaint findings. LPA met with Jennifer Rivas as the purpose of the visit was explained.
The investigation consisted of the following: On 03/06/24 LPA Villegas requested copies of the staff and resident rosters, communication documentation regarding R1’s discharge from facility dated 05/29/24, narrative charting notes dated 01/01/24-05/08/24, admission agreement dated 04/09/09, physicians report dated 05/02/24, preplacement appraisal dated 04/09/09, and rent invoice for May 2024. On 06/12/2024 The Department obtained copies of the staff roster, resident roster, reviewed 7 out of 7 residents file, admission agreements, medication administration records, discharge paperwork, and requested copies of eviction documents. The department interviewed staff#1-5 (S1-S5), and Residents #2-7 (R2-R7). On 03/06/25 LPA Villegas conducted phone interview with Staff #6 (S6).
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Janae HammondTELEPHONE: (424) 544-1027
LICENSING EVALUATOR NAME: Lizeth VillegasTELEPHONE: (818) 391-9974
LICENSING EVALUATOR SIGNATURE:

DATE: 03/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2025
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 5
Control Number 11-AS-20240603132824
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
FACILITY NAME: CHATEAU LONG BEACH
FACILITY NUMBER: 197800131
VISIT DATE: 03/06/2025
NARRATIVE
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Allegation: Facility did not issue a refund to a resident in care.

It is being alleged that the facility did not refund a resident after resident moved out of the facility. On 06/12/2024 The department conducted interviews with S1-S5, 5 of 5 residents interviewed denied the allegation above. On 06/12/24 The department conducted interviews with R2-R7 regarding the allegation above, 6 of 6 residents interviewed denied the allegation above. On 06/12/24 The department was unable to interview R1 due to R1 no longer receiving services at Chateau Long Beach. On 03/05/25 LPA Villegas conducted phone interview with former Administrator (A1) regarding the allegation above, Per A1 A1 was no longer working for the facility and A1 has no information on the allegation above. On 03/06/25 LPA Villegas conducted phone interview with (S6) regarding the allegation above, S6 denied the allegation above and stated R1 was removed from the facility by family at the end of the month therefore there was no refund issued. Per S6 R1’s belongings were picked up by family member on 5/29/24.

Based on LPAs observations and interviews which were conducted record review(s), the preponderance of evidence standard has been met, therefore the above allegation(s) is found to be substantiated. California Code of Regulations, Title 22, Division (6) and Chapter (8)are being cited on the attached LIC 9099D.



Exit interview conducted, appeal rights explained, and a copy of this report was provided.
SUPERVISOR'S NAME: Janae HammondTELEPHONE: (424) 544-1027
LICENSING EVALUATOR NAME: Lizeth VillegasTELEPHONE: (818) 391-9974
LICENSING EVALUATOR SIGNATURE:

DATE: 03/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 11-AS-20240603132824
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

FACILITY NAME: CHATEAU LONG BEACH
FACILITY NUMBER: 197800131
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/06/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/20/2025
Section Cited
CCR
87507(5)(D)
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Admission Agreements
The refund of prepaid monthly fees for any condition listed in (C)1. and (C)2. above shall be given as specified below: If the resident does not provide the above 5-day notice the licensee shall refund a proportional daily amount of any prepaid monthly fee(s)
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Submit a plan to dept outlining the steps they will take to get into compliance with title 22 regulations. Plan to be submitted to LPA by POC due date.
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 within seven days from the date that the resident leaves the facility, and the unit is vacated. The licensee did not comply with the section above as Facility failed to provide R1 with refund when the residents belongings were removed from the facility by family on 05/29/24.
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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 HammondTELEPHONE: (424) 544-1027
LICENSING EVALUATOR NAME: Lizeth VillegasTELEPHONE: (818) 391-9974
LICENSING EVALUATOR SIGNATURE:

DATE: 03/06/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/03/2024 and conducted by Evaluator Lizeth Villegas
COMPLAINT CONTROL NUMBER: 11-AS-20240603132824

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: 91DATE:
03/06/2025
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Assistant Administrator Jennifer Rivas TIME COMPLETED:
01:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility illegally evicted a resident in care.
INVESTIGATION FINDINGS:
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The investigation consisted of the following continued:

Allegation: Facility illegally evicted a resident in care.

It is being alleged that the facility refused to allow a resident to return to the facility after hospital discharge. On 06/12/2024 The department conducted interviews with S1-S5, 5 of 5 staff interviewed denied the allegation above. 5 of 5 staff indicated that the facility adheres strictly to state regulations regarding resident discharges, providing written notice at least 60 days in advance, with no exceptions. S1-S5 stated no residents have been illegally evicted. On 06/12/24 The department conducted interviews with R2-R7 regarding the allegation above, 6 of 6 residents interviewed denied the allegation above. On 06/12/24 The department was unable to interview R1 due to R1 no longer receiving services at Chateau Long Beach.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Janae HammondTELEPHONE: (424) 544-1027
LICENSING EVALUATOR NAME: Lizeth VillegasTELEPHONE: (818) 391-9974
LICENSING EVALUATOR SIGNATURE:

DATE: 03/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 11-AS-20240603132824
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
FACILITY NAME: CHATEAU LONG BEACH
FACILITY NUMBER: 197800131
VISIT DATE: 03/06/2025
NARRATIVE
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On 03/05/25 LPA Villegas conducted phone interview with former Administrator (A1) regarding the allegation above, A1 denied the allegation above and stated the facility wanted to ensure the facility could met R1’s care needs. On 03/06/25 LPA Villegas conducted phone interview with (S6) regarding the allegation above, S6 denied the allegation above and reported resident no longer met the criteria upon in per son re-assessment. On 03/06/25 LPA Villegas conducted a records review for R1, LPA did not observe an eviction notice in R1’s file.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated.

Exit interview was conducted, and a copy of this report was provided.

SUPERVISOR'S NAME: Janae HammondTELEPHONE: (424) 544-1027
LICENSING EVALUATOR NAME: Lizeth VillegasTELEPHONE: (818) 391-9974
LICENSING EVALUATOR SIGNATURE:

DATE: 03/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/06/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 5