198320114-5-18-2022-11-AS-MVAO-CFNTK3-20220623144716

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198320114
Report Date: 05/18/2022
Date Signed: 05/18/2022 03:57:42 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
05/16/2022 and conducted by Evaluator Jade Jordan

COMPLAINT CONTROL NUMBER: 11-AS-20220516134519

FACILITY NAME:	SUNCOAST SENIOR LIVING AT LONG BEACH		FACILITY NUMBER:	198320114
ADMINISTRATOR:	KIM, KI HWAN		FACILITY TYPE:	740
ADDRESS:	2520 GONDAR AVE		TELEPHONE:	(718) 683-1000
CITY:	LONG BEACH	STATE: CA	ZIP CODE:	90815
CAPACITY:	6	CENSUS: 2	DATE:	05/18/2022
		UNANNOUNCED	TIME BEGAN:	09:51 AM
MET WITH:	Ki Hwan Kim Licensee; Stephanie Kim Administrator		TIME COMPLETED:	03:53 PM

ALLEGATION(S):

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“Resident Hygiene Needs Not Being Met”

INVESTIGATION FINDINGS:

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On 05/18/22 Licensing Program Analyst (LPA) Jade Jordan Conducted an Unannounced visit regarding the allegation(s) above. LPA was met by Facility Licensee, and Administrator Ki and Stephanie Kim. The Purpose of the visit was explained.

Investigation Consisted of: Physical Tour, Interviews with Staff, Residents, Hospice Agency, Record Review and copies were requested of : Hospice Services, Admissions Agreement, Physicians Report, and other copies pertinent relating to the allegation.

Regarding Allegation “Resident Hygiene Needs Not Being Met”
On 05/14/22 A complaint report was made regarding the hygeine needs of Resident 1 (R1)
Interviews conducted with Licensee revealed that they use a Hospice Agency Named “Next Care Hospice” and that two of their residents, are currently receiving services. Both Resident’s (R1), and (R2), have a shower schedule of Monday, Wednesdays, and Fridays. Hospice Last Showered R1 on Friday May 13th, 2022.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Ulysses Coronel	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Jade Jordan	TELEPHONE: (650) 388-2300
LICENSING EVALUATOR SIGNATURE:	DATE: 05/18/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/18/2022

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 11-AS-20220516134519

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: SUNCOAST SENIOR LIVING AT LONG BEACH	FACILITY NUMBER: 198320114
	VISIT DATE: 05/18/2022

NARRATIVE

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On Monday, 05/16/22 the Licensee inquired about what time the Hospice Aid would be arriving for shower schedule, they received a text message from the hospice staff at 10:36am Stating that “A new shower aid has been assigned to your patients, they should be contacting you anytime.”

It was revealed by Licensee, since hospice did not arrive as scheduled, R1 was given a bed bath in their room, on 05/16/22 by Administrator, Licensee, and facility staff, around 12pm. Licensee stated that “they are the one who physically picks up the resident to place Residents in shower chair.”

LPA observed on 05/18/22 at 12:50pm hygiene products in the facility such as soap, water, diapers, ointment, towels to assist with bathing.

On Wednesday, 05/18/22 LPA observed at 1:40PM hospice staff, entering the facility. LPA observed Hospice Staff in the Room of R1, and they confirmed that they were there to bathe both R1 and R2. Hospice staff also confirmed that it was it first day at the facility to conduct bathing.

LPA attempted to conduct Interviews with R1-R2, but residents were not responsive.

Based on Interviews, Record Review, and Observation the department finds that “Although the allegation may have happened or is valid, there is not preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated.”

An Exit Interview was conducted, and a copy of this report was provided. No citations were issued during this visit.

SUPERVISOR'S NAME: Ulysses Coronel	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Jade Jordan	TELEPHONE: (650) 388-2300
LICENSING EVALUATOR SIGNATURE:	DATE: 05/18/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/18/2022

LIC9099 (FAS) - (06/04)

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