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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197800131
Report Date: 06/12/2024
Date Signed: 09/19/2024 10:06:19 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, 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 David Espana
PUBLIC
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: 73DATE:
06/12/2024
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Jared Mikos, Director of OperationsTIME COMPLETED:
04:00 PM
ALLEGATION(S):
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Facility illegally evicted a resident in care.
Facility did not issue a refund to a resident in care.
INVESTIGATION FINDINGS:
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**This report serves as an amendment to clarify findings. It does not supersede the complaint investigation findings reflected on report created 06/12/2024.**

On 06/12/2024 at 09:00 am Licensing Program Analyst (LPA) David España conducted an initial complaint investigation visit for the allegation listed above. Upon arriving at the facility, LPA España met with Administrator Khatera Bahadory who assisted with the visit.

The purpose of today’s visit was discussed. Upon arrival at the facility, LPA España conducted a risk assessment at the front door. Based on the assessment, the facility is clear of Covid-19 infection. LPA España was granted access and allowed to enter the facility to conduct investigation.

COMPLAINT INVESTIGATION REPORT LIC 9099C CONTINUED
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Stephanie CifuentesTELEPHONE: (661) 644-7743
LICENSING EVALUATOR NAME: David EspanaTELEPHONE: (323) 400-7109
LICENSING EVALUATOR SIGNATURE:

DATE: 09/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/19/2024
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 4
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: 06/12/2024
NARRATIVE
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SUPERVISOR'S NAME: Stephanie CifuentesTELEPHONE: (661) 644-7743
LICENSING EVALUATOR NAME: David EspanaTELEPHONE: (323) 400-7109
LICENSING EVALUATOR SIGNATURE:

DATE: 06/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/12/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 4
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: 06/12/2024
NARRATIVE
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Investigation consisted of the following: On 06/12/2024 LPA España requested a copy 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. LPA España interviewed staff 1-staff 5 (S1-S5) and Resident 1-Resident 7 (R1-R7).

The investigation consisted of the following continued:

Allegation: Facility illegally evicted a resident in care.

On 06/12/2024 LPA Espana interviewed Staff 1-Staff 5 (S1-S5). S1-S5 confirmed 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 also reported no attempts to transfer or relocate residents in the past 90 days. S1-S5 stated no resident was illegally evicted.

On 06/12/2024 LPA Espana interviewed Administrator Khatera Bahadory who stated that 1 resident required a higher level of care and left the facility on May 29, 2024. The resident's doctor and family were informed, and the family managed the resident's transition to a skilled nursing facility. The administrator presented documentation showing a signed acknowledgment from the family for discharge on the specified date. On 06/12/2024 LPA España attempted (by telephone) to interview R8, but they were unavailable.
SUPERVISOR'S NAME: Stephanie CifuentesTELEPHONE: (661) 644-7743
LICENSING EVALUATOR NAME: David EspanaTELEPHONE: (323) 400-7109
LICENSING EVALUATOR SIGNATURE:

DATE: 09/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/19/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 4
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: 06/12/2024
NARRATIVE
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On 06/12/2024 LPA Espana interviewed Resident 1-Resident 7 (R1-R7) who were unaware of any recent transfer attempts or issues with illegal evictions. They were also unfamiliar with the facility's eviction process. On 06/12/2024 LPA España attempted (by telephone) to interview R8, but they were unavailable.

Based on LPA’s observation, interviews conducted and records reviews, the preponderance of evidence standard has not been met. Although the allegation 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 allegation is Unsubstantiated.

Allegation: Facility did not issue a refund to a resident in care.

On 06/12/2024 LPA España interviewed the Administrator Khatera Bahadory who reported no discharges due to nonpayment in the last 90 days. The facility provides residents time to seek financial assistance before any discharge. The Administrator Khatera Bahadory also explained that the facility's eviction policy requires a 60-day notice, and there has not been refund issues with any resident, all procedures are followed accordingly. On 06/12/2024 LPA España interviewed S1-S5 confirmed that detailed documentation is maintained for any discharge process, including reasons and notices provided. On 06/12/2024 LPA España interviewed R1-R7 who were unaware of any refund issues or illegal evictions. R1-R7 confirmed that the facility's discharge procedures are consistently followed and had no knowledge of involuntary discharges. On 06/12/2024 LPA España attempted (by telephone) to interview R8, but they were unavailable. Based on LPA España’s observation, interviews conducted and records reviews, the preponderance of evidence standard has not been met. Although the allegation 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 allegation is Unsubstantiated.

An exit interview was conducted with Jared Mikos, Director of Operations and a hard copy was provided.
SUPERVISOR'S NAME: Stephanie CifuentesTELEPHONE: (661) 644-7743
LICENSING EVALUATOR NAME: David EspanaTELEPHONE: (323) 400-7109
LICENSING EVALUATOR SIGNATURE:

DATE: 09/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/19/2024
LIC9099 (FAS) - (06/04)
Page: 4 of 4