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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197800131
Report Date: 01/21/2026
Date Signed: 01/21/2026 04:09:15 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
01/15/2026 and conducted by Evaluator Lizeth Villegas
COMPLAINT CONTROL NUMBER: 11-AS-20260115090806
FACILITY NAME:CHATEAU LONG BEACHFACILITY NUMBER:
197800131
ADMINISTRATOR:ESPERANZA NAAKTGEBORENFACILITY TYPE:
740
ADDRESS:3100 E. ARTESIA BLVD.TELEPHONE:
(562) 428-5371
CITY:LONG BEACHSTATE: CAZIP CODE:
90805
CAPACITY:184CENSUS: 101DATE:
01/21/2026
UNANNOUNCEDTIME BEGAN:
09:05 AM
MET WITH:Administrator Esperanza NaaktgeborenTIME COMPLETED:
04:15 PM
ALLEGATION(S):
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Staff did not provide resident with a pre-admission appraisal.
INVESTIGATION FINDINGS:
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On 01/21/26 at 9:00 am Licensing Program Analyst (LPA) Villegas conducted an initial complaint visit regarding the allegation(s) above. LPA met with Administrator as the purpose of today’s visit was explained.

The investigation consisted of the following: On 01/21/26 LPA Villegas obtained copies of the staff and resident roster, and copies of the following documents for Resident #1 (R1) Emergency ID form, resident assessment form dated: 01/15/26, admission agreement dated: 01/15/26, Physicians report dated:12/19/25, Individual service plan dated: 12/16/25, Advanced health care directive dated: 05/07/24, a copy of the Dual power of attorney for management of property and personal affairs dated: 05/7/24. On 01/21/26 from 10:00 am- 12pm LPA conducted Interviews residents # 1-10 (R1-R10) and from 1:15pm- 2pm LPA conducted interviews with staff #1-4 (S1-S4). On 01/21/25 LPA conducted a review of R1's file.

The investigation revealed the following:

Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Lizeth Villegas
LICENSING EVALUATOR SIGNATURE:

DATE: 01/21/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/21/2026
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-20260115090806
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: 01/21/2026
NARRATIVE
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Allegation: Staff did not provide resident with a pre-admission appraisal.

It is being alleged that staff did not perform a pre-appraisal to assess and confirm if the facility is able to meet R1's needs. On 01/21/26 from 10:00 am- 12pm LPA conducted Interviews with R1-R10 regarding the allegation above. 7 of 10 residents interviewed denied the allegation above and reported that someone from Chateau of Long Beach spoke to them about the facility and the services offered. 2 of 10 residents interviewed confirmed the allegation above, 1 of 10 residents reported they do not remember if a pre-admission appraisal was conducted. On 01/21/26 from 1:15pm- 2pm LPA conducted interviews with S1-S4 regarding the allegation above. S1 denied the allegation above and stated that a resident assessment was conducted, however it was never dated. During interviews with S2-S4 regarding the allegation above, 3 of 3 staff interviewed confirmed the allegation above and stated that a pre- admission appraisal was not conducted for R1 prior to admission. On 01/21/26 LPA conducted a review of R1's facility file, LPA did not observe any documentation indicating that a pre-admission appraisal was completed prior to when R1 moving in and started receiving services at Chateau of Long Beach.

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.
SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Lizeth Villegas
LICENSING EVALUATOR SIGNATURE:

DATE: 01/21/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/21/2026
LIC9099 (FAS) - (06/04)
Page: 2 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
01/15/2026 and conducted by Evaluator Lizeth Villegas
COMPLAINT CONTROL NUMBER: 11-AS-20260115090806

FACILITY NAME:CHATEAU LONG BEACHFACILITY NUMBER:
197800131
ADMINISTRATOR:ESPERANZA NAAKTGEBORENFACILITY TYPE:
740
ADDRESS:3100 E. ARTESIA BLVD.TELEPHONE:
(562) 428-5371
CITY:LONG BEACHSTATE: CAZIP CODE:
90805
CAPACITY:184CENSUS: 101DATE:
01/21/2026
UNANNOUNCEDTIME BEGAN:
09:05 AM
MET WITH:Administrator Esperanza NaaktgeborenTIME COMPLETED:
04:15 PM
ALLEGATION(S):
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2
3
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9
Staff did not provide resident with an admissions agreement.
INVESTIGATION FINDINGS:
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On 01/21/26 at 9:00 am Licensing Program Analyst (LPA) Villegas conducted an initial complaint visit regarding the allegation(s) above. LPA met with Administrator as the purpose of today’s visit was explained.

The investigation consisted of the following: On 01/21/26 LPA Villegas obtained copies of the staff and resident roster, and copies of the following documents for Resident #1 (R1) Emergency ID form, resident assessment form dated: 01/15/26, admission agreement dated: 01/15/26, Physicians report dated:12/19/25, Individual service plan dated: 12/16/25, Advanced health care directive dated: 05/07/24, and a copy of the Dual power of attorney for management of property and personal affairs dated: 05/7/24. On 01/21/26 from 10:00 am- 12pm LPA conducted Interviews residents # 1-10 (R1-R10) and from 1:15pm- 2pm LPA conducted interviews with staff #1-4 (S1-S4). On 01/21/25 LPA conducted a review of R1's file.

Allegation: Staff did not provide resident with an admissions agreement.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Lizeth Villegas
LICENSING EVALUATOR SIGNATURE:

DATE: 01/21/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/21/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 11-AS-20260115090806
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: 01/21/2026
NARRATIVE
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It is being alleged that facility staff did not provide R1 with an admissions agreement per Title 22 regulations. On 01/21/26 from 10:00 am- 12pm LPA conducted Interviews with R1-R10 regarding the allegation above. 4 of 10 residents interviewed denied the allegation above and reported that a signed copy of their admission agreement was provided by facility staff, 1 of 10 residents interviewed confirmed the allegation above and stated they did not receive a signed copy of their admission agreement, and 5 of 10 residents interviewed stated that they cannot remember if they received a signed copy of their admission agreement. On 01/21/26 from 1:15pm- 2pm LPA conducted interviews with S1-S4 regarding the allegation above. During interview with S1, S1 denied the allegation above and reported that a copy of the signed admission agreement was offered to R1 and family, however R1 nor family wanted a copy. During interviews with S2-S4 regarding the allegation above, 2 of 3 staff reported that a copy of the signed admission agreement is always offered. 1 of 3 staff reported that a copy of a signed admission agreement is not provided unless requested by a resident. On 01/21/26 LPA conducted a review of R1's facility file, LPA observed that there was a completed admission agreement on file, LPA also observed that R1 signed the admission agreement dated 01/15/26.

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 conducted, and a copy of this report was provided.
SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Lizeth Villegas
LICENSING EVALUATOR SIGNATURE:

DATE: 01/21/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/21/2026
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 11-AS-20260115090806
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: 01/21/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/04/2026
Section Cited
CCR
87457(a)(1)
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87457 Pre-Admission Appraisal. Prior to admission, the prospective resident and his/her responsible person, if any, shall be interviewed by the licensee or the employee responsible for facility admissions. Sufficient information about the facility and its services shall be provided...Based on
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Licensee, Administrator, and all staff who assist with pre admission appraisals and admission to review regulation cited, and ensure all pre admission appraisals are conducted prior to resident officially moving into the facility and receiving services. LPA to receive by POC due
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involved in the placement to make an interviews and record review, facility staff failed to ensure a pre admission appraisal was done prior to R1 receiving services/ moving intoThe Chateau of Long Beach, which poses a potential health and safety risk to residents in care.
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date, astatement from Licensee/Administrator indicating that regulation has been reviewed and is understood
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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.
SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Lizeth Villegas
LICENSING EVALUATOR SIGNATURE:

DATE: 01/21/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/21/2026
LIC9099 (FAS) - (06/04)
Page: 5 of 5