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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198602039
Report Date: 11/30/2023
Date Signed: 11/30/2023 05:25:29 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 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
08/11/2023 and conducted by Evaluator Mario Leon
PUBLIC
COMPLAINT CONTROL NUMBER: 11-AS-20230811153533
FACILITY NAME:REGENT VILLA RETIREMENT HOMEFACILITY NUMBER:
198602039
ADMINISTRATOR:GORDON, JENNIFACILITY TYPE:
740
ADDRESS:201 W WARDLOW RDTELEPHONE:
(562) 595-6529
CITY:LONG BEACHSTATE: CAZIP CODE:
90807
CAPACITY:188CENSUS: 144DATE:
11/30/2023
UNANNOUNCEDTIME BEGAN:
08:35 AM
MET WITH:Jenni Gordon, AdministratorTIME COMPLETED:
05:36 PM
ALLEGATION(S):
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Facility staff did not seek medical attention in a timely manner.
INVESTIGATION FINDINGS:
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On 11/30/23 Licensing Program Analyst (LPA) Mario Leon conducted a subsequent, unanounced, complaint investigation visit to the above-mentioned facility. LPA arrived at facility and was met by Jenni Gordon, Administrator, and explained the purpose of the visit.

The investigation consisted of the following:
On 08/21/23, LPA toured the inside and outside of the facility. During the course of the investigation LPA requested and received copies of the following: client roster, staff roster; ID and emergency information, physicians’ reports, resident appraisal and all medical records for Resident #1 (R1).
On 11/30/23, LPA interviewed ten (10) out of one-hundred and forty-four (144) residents and seven (7) out of thirty-nine (39) staff. LPA obtained heart rate, blood pressure, blood sugar and insulin dosing of R1 for the month of admission January 2023. LPA obtained training records for Licensed Vocational Nurses (LVN) (S4-S5) and Caregivers (S3,S6), along with FirstAid/CPR certificates (S3-S6). Report Continues, see LIC9099C.
Unsubstantiated
Estimated Days of Completion: 90
SUPERVISOR'S NAME: Ulysses CoronelTELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Mario LeonTELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:

DATE: 11/30/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/30/2023
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 2
Control Number 11-AS-20230811153533
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME: REGENT VILLA RETIREMENT HOME
FACILITY NUMBER: 198602039
VISIT DATE: 11/30/2023
NARRATIVE
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LPA also received three (3) declarations from Jenni Gordon (S1), Noemi Callimquim (S3) and Elizabeth Gibson (S4).

The investigation revealed the following:


Regarding the allegation: "Facility staff did not seek medical attention in a timely manner." It has been alleged that Resident one's (R1) medical care departed from the prevailing professional standard of care.

According to LPA's record reviews Noemi Calimquim, Med-Tech (S3), was the first to receive the call light provided from roommate Resident #2 (R2). R2 pulled the call light at 6:50PM, due to Resident #1's (R1) fall. Nelia Ramos, Caregiver (S6), responded to the call light at 6:54PM. At 6:55PM S6 then informed S4, who went to observe R1's heart-rate and blood-pressure, measured at 174mg/dl, recorded at 7:00PM. S4 requested S3 to call 911. According to LiveFireRECORDS Incident Report, Long Beach Fire Department (LBFD) received the alarm at 7:03PM and later arrived to the above-mentioned facility at 7:07PM. During that time, LBFD delivered CPR, beginning at 7:08PM. Anaphalaxis (EPI) was provided and a restart of a sustained heart rhythm (ROSC) was obtained at 7:20PM, which was sustained for two (2) minutes, after which R1 rearrested with Pulseless Electrical Activity (PEA). Sodium Bicarbonate and Calcium Chloride was given to R1 per base orders along with additional EPI for total of 4units. CPR was given to patient for 29 minutes, with a final rhythm of Asystole and R1 was then pronounced deceased at 7:37PM.

According to LPA's interviews, the staff responded to the call light within four (4) minutes. After Staff's observations and assistance, Emergency Medical Services (LBFD) were contacted approximately eight (8) minutes after S3 received the non-responsive report of R1 from S6, around 7:03PM.

LPA interviewed 7 staff (S1-S7). All staff have denied the allegation. LPA interviewed 10 residents (R2-R11). Nine (9) out of 10 residents have disagreed with the allegation and have stated that they feel that their medical needs are being appropriately met and that if emergency services were needed, their needs would be met.

Based on record reviews and interviews conducted, 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 that the alleged violation occurred. Therefore, the above allegation has been Unsubstantiated.

There have been no deficiencies cited during this visit. An exit interview was held with Administrator, Jenni Gordon (S1) and a copy of this report has been provided.

SUPERVISOR'S NAME: Ulysses CoronelTELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Mario LeonTELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:

DATE: 11/30/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/30/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 2