<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198602069
Report Date: 08/03/2021
Date Signed: 08/03/2021 05:03:14 PM



STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office,
, CA
This is an official report of an unannounced visit/investigation of a complaint received in our office on
02/20/2020 and conducted by Evaluator Nicol Wesley
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20200220130538
FACILITY NAME:PALMCREST GRAND RESIDENCEFACILITY NUMBER:
198602069
ADMINISTRATOR:STREICHER, RACHELFACILITY TYPE:
740
ADDRESS:3503 CEDAR AVENUETELEPHONE:
(562) 595-4551
CITY:LONG BEACHSTATE: CAZIP CODE:
90807
CAPACITY:262CENSUS: 115DATE:
08/03/2021
UNANNOUNCEDTIME BEGAN:
02:45 PM
MET WITH:Peggy Clark TIME COMPLETED:
05:20 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility staff did not administer resident's medication as prescribed.
Facility staff did not ensure resident was using medical device as prescribed.
Facility staff did not launder resident's clothing in a timely manner.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analysts (LPAs) Nicol Wesley and Nune Margaryan conducted a subequent complaint visit and met with Assistant Program Manager Peggy Clark to discuss the purpose for todays visit.

Investigation consisted of the following: During todays visit, LPAs requested to review resident #1's file and to review the medication log and records. On 02/21/2020 LPA requested a copy of the resident and staff roster and interviewed Program Manager Peggy Clark, Assistant Administrator Erin Fiore and Administrator Russell Amparano. LPA Wesley also interview other parties.

Regarding allegation: Facility staff did not administer resident's medication as prescribed and Facility staff did not ensure resident was using medical device as prescribed. During the interviews with the Administrator and the Assistant Administrator they advised that resident #1 was receiving their medication as prescribed since they

Continued on LIC 9099C.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Rebecca OrendainTELEPHONE: (323) 981-3961
LICENSING EVALUATOR NAME: Nicol WesleyTELEPHONE: (323) 981-3975
LICENSING EVALUATOR SIGNATURE:

DATE: 08/03/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/03/2021
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 28-AS-20200220130538
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office,
, CA
FACILITY NAME: PALMCREST GRAND RESIDENCE
FACILITY NUMBER: 198602069
VISIT DATE: 08/03/2021
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
moved into the facility in December of 2019. Administrator advised that the Medication Technicians issue the residents medication in a timely manner and according to the doctors orders. It was also communicated that there was a discrepancy with resident #1's medical insurance and due to their age of resident #1, there were issues with the type of medical coverage they qualify for and resident #1's family had to incur out of pocket expenses for some of resident 1#'s medication and this was a result of the resident previously residing out of State. The Assistant Administrator also said that when resident #1 arrived to the facility, the family provided them with some of resident #1's medication but there was no listed medi cation for seizures, and there was no medical equipment for sleep apnea in which the family was supposed to provide per their discussion during the virtual pre placement interview. LPA interviewed staff #2 and they did not recall resident #1 as they were out of leave during that time, but did say they distribute all medication on time and according to the doctors. During the interview with staff #3 they said they give resident medication on time according to the doctors orders. Staff #3 recalled having conversations with resident #1's family and having to constantly contact them in regards to getting resident #1's prescriptions refilled. Staff #3 advised that they informed resident #1s family that they could get the refills set up through the facility pharmacy but the family declined and said the resident had their own doctor and they had a pharmacy that they used because the medical insurance did not coverage all the residents medication so they had to pay for some of the medication out of pocket. Staff #3 informed the LPA that they never received any medication for seizures and said the family never provided the a facility with a CPAP machine for resident #1 to use at night, although it was previously discussed that the resident used one prior to coming to California. LPA reviewed the MAR log and did not see any prescriptions for seizure medication or a CPAP device. During the file review, LPA Wesley did not observe any current literature/prescriptions/doctors order that listed any current use of seizure medication or a CPAP device. During the investigation it was observed that when resident #1 resided out of staff, the medication was issued once in August 2019 as a preventative measure, there was no records/prescription/doctor orders for a CPAP machine in California, however there was indication that resident #1 did utilize a CPAP machine prior to residing at Palmcrest Grand back in October 2019. During the interviews with residents, they informed the LPA that they never had a problem with their prescribed medication being issued in a timely manner and said that the medication was given to them as prescribe at specific times of the day. LPA Wesley attempted to contact resident #1 and their responsible party and was informed that resident #1 had passed away. LPA attempted to interview other parties and was informed that they did not wish to speak to me or discuss or the matter any further. There is no evidence to support the allegations: Facility staff did not administer resident's medication as prescribed and Facility staff did not ensure resident was using medical device as prescribed.
Continued on LIC 9099 Page 3.
SUPERVISOR'S NAME: Rebecca OrendainTELEPHONE: (323) 981-3961
LICENSING EVALUATOR NAME: Nicol WesleyTELEPHONE: (323) 981-3975
LICENSING EVALUATOR SIGNATURE:

DATE: 08/03/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/03/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 28-AS-20200220130538
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office,
, CA
FACILITY NAME: PALMCREST GRAND RESIDENCE
FACILITY NUMBER: 198602069
VISIT DATE: 08/03/2021
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Regarding allegation: Facility staff did not launder resident's clothing in a timely manner. During the interviews with the assistant Administrator Fiore, LPA Wesley was informed that resident #1 soiled their garments more frequent that usual and the resident had limited underclothes and garments. The Assistant Administrator said when they called the family to bring the resident additional clothes, they agreed, but never bought them to the facility. Staff #1 was interviewed and said that each resident has an assigned laundry day and that resident #1 did not have a variety of garments to wear and denied that garment were in a hamper soiled with urine as the resident #1 clothing was so limited, they had to wash the residents clothes daily as they were incontinent. Staff #4 also who also said resident #1 was incontinent would also have to assist with the frequent washing of resident #1's clothes as they only had a few articles of clothing and when they requested additional clothing from the family, they never received any. Staff #4 denied that there was soiled garments in a hamper filled urine and also said they had to provide the resident with additional showers. LPA Wesley attempted to contact resident #1 and their responsible party and was informed that resident #1 had passed away. LPA attempted to interview other parties and was informed that they did not wish to speak to me or discuss or the matter any further. LPA interviewed a random selection of residents who said they do not have any problems with staff washing their clothing, and they have never had soiled clothing especially saturated with urine There is no evidence to support the allegation Facility staff did not launder resident's clothing in a timely manner.

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.

There are no deficiencies cited and a copy of this report was given during the exit interview.
SUPERVISOR'S NAME: Rebecca OrendainTELEPHONE: (323) 981-3961
LICENSING EVALUATOR NAME: Nicol WesleyTELEPHONE: (323) 981-3975
LICENSING EVALUATOR SIGNATURE:

DATE: 08/03/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/03/2021
LIC9099 (FAS) - (06/04)
Page: 3 of 3