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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198320114
Report Date: 01/24/2025
Date Signed: 02/19/2025 02:28:47 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
09/24/2024 and conducted by Evaluator Deborah Lee
COMPLAINT CONTROL NUMBER: 11-AS-20240924120338
FACILITY NAME:SUNCOAST SENIOR LIVING AT LONG BEACHFACILITY NUMBER:
198320114
ADMINISTRATOR:KIM, KI HWANFACILITY TYPE:
740
ADDRESS:2520 GONDAR AVETELEPHONE:
(718) 683-1000
CITY:LONG BEACHSTATE: CAZIP CODE:
90815
CAPACITY:6CENSUS: 5DATE:
01/24/2025
UNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Ki Hwan KimTIME COMPLETED:
04:00 PM
ALLEGATION(S):
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Staff interfered with resident's visit with the Long Term Care Ombudsman
INVESTIGATION FINDINGS:
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** This report serves to amend the 9099D.It does not supersede the complaint investigation findings reflected on report created on 1/24/25 **
On January 24, 2025, Licensing Program Analyst (LPA) Deborah Lee arrived at the facility listed above for the purpose of continuing investigation started on 10/3/24 and to deliver findings for the above identified complaint allegation. LPA Lee met with Licensee/Administrator Tony Kim and explained the reason for today’s visit. There was one staff (S1) at facility at time of visit.

The complaint alleges that Licensee/Administrator Tony Kim insisted on supervising the Long Term Care Ombudsman (LTCO) while she spoke with the residents.

The investigation consisted of the following: LPA Lee conducted tour of facility both inside and out, LPA reviewed and obtained copies of the following: client roster, staff roster, Appraisal/Needs and Services plans for (R1), Physicians reports for (R1), interviews were conducted with the following: Licensee/Administrator, LTCO (via telephone), Staff #1 (S1) and Residents (R1-R5)

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Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Deborah Lee
LICENSING EVALUATOR SIGNATURE:

DATE: 02/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/19/2025
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 3
Control Number 11-AS-20240924120338
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: SUNCOAST SENIOR LIVING AT LONG BEACH
FACILITY NUMBER: 198320114
VISIT DATE: 01/24/2025
NARRATIVE
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Allegation: Staff interfered with resident's visit with the Long Term Care Ombudsman

Regarding the allegation: Licensee/Administrator Tony Kim interfered with resident's visit with the LTCO (W1). It is alleged that W1 arrived at facility to conduct an annual visit on 8/30/24 when the Licensee/administrator (Tony Kim) insisted on supervising W1 while she spoke with resident (R1); therefore, interfering with her duties .

On November 5, 2024, Licensing Program Manager (LPM) Eva Alvarez and Licensing Program Analyst (LPA) Deborah Lee conducted a telephone interview with W1 who confirmed the allegation stating that she was interfered with while conducting her duty of meeting privately with the residents. When explaining that she had authority to meet privately with residents without interference, Mr. Kim continued to argue about her being in the resident's room without him. W1 further stated that she decided to terminate the visit because Mr. Kim wanted the visit to be on “his terms” by being present during her meeting with residents which goes against their rights to meet with the LTCO privately.

On November 5, 2024, LPA Lee interviewed Licensee/Administrator Tony Kim via telephone who informed her that during W1’s visit to the facility, while in R1’s room, he needed to be present with W1 for safety reasons but W1 stated that she needed to speak privately with R1. According to Mr. Kim, W1 began yelling, “I can go anywhere I want, and you can’t stop me!” Mr. Kim further stated that he told her to “get out of the room right now and get your supervisor on the phone.” Lastly, Mr. Kim stated that shortly after W1 and her supervisor spoke on the phone privately outside of facility, W1 said she was ending her visit and left the facility.

On January 24, 2025, LPA interview with staff 1 (S1) reveal that residents' family and other visitors have met privately with residents.

Interviews with R1-R5 reveal that (1 ) out of ( 5) residents is familiar with a Long Term Care Ombudsman (LTCO) and after LPA Lee explained what a LTCO does, ( 4 ) out of ( 5) residents said they would be okay with meeting and speaking with an LTCO privately.

Based on interviews conducted, the preponderance of evidence standard has been met therefore the above allegation is found to be SUBSTANCIATED.

Citation issued during today’s visit please see LIC 9099D

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Deborah Lee
LICENSING EVALUATOR SIGNATURE:

DATE: 02/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/19/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Citations on this Visit Report are Under Appeal!

Control Number 11-AS-20240924120338
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: SUNCOAST SENIOR LIVING AT LONG BEACH
FACILITY NUMBER: 198320114
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/24/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Under Appeal
Type B
03/07/2025
Section Cited
CCR
87468(a)(11)
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Personal Rights. (a) Each resident shall have personal rights which include, but are not limited to, the following:
(11) To have his/her visitors, including ombudspersons and advocacy representatives permitted to visit privately...provided that the rights of other residents are not infringed upon.

This requirement was not met as evidenced by
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Licensee to come up with a plan to allow privacy for subsequent visits from the Long Term Care Ombudsman. Plan to be submitted to LPA via email by due date (03/07/2025) Deborah.Lee@dss.ca.gov.
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Based on interviews, the licensee did not comply with the section cited above as he prevented the Long Term Care Ombudsmen from speaking privately with Resident in care which poses an immediate personal rights risk to persons in care.
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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: Eva M Alvarez
LICENSING EVALUATOR NAME: Deborah Lee
LICENSING EVALUATOR SIGNATURE:

DATE: 02/19/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/19/2025
LIC9099 (FAS) - (06/04)
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