198602069-3-14-2021-11-AS-MVAO-BZ6N7D-20210316101233

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198602069
Report Date: 03/14/2021
Date Signed: 03/14/2021 12:04:05 PM

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
10/29/2020 and conducted by Evaluator Jennifer Jones

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20201029150702

FACILITY NAME:	PALMCREST GRAND RESIDENCE		FACILITY NUMBER:	198602069
ADMINISTRATOR:	STREICHER, RACHEL		FACILITY TYPE:	740
ADDRESS:	3503 CEDAR AVENUE		TELEPHONE:	(562) 595-4551
CITY:	LONG BEACH	STATE: CA	ZIP CODE:	90807
CAPACITY:	262	CENSUS: 107	DATE:	03/14/2021
		UNANNOUNCED	TIME BEGAN:	11:00 AM
MET WITH:	Lesly Figueroa, Administrator		TIME COMPLETED:	12:00 PM

ALLEGATION(S):

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Resident's are receiving insulin injections by unqualified individuals.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Jennifer Jones initiated a complaint investigation and delivered findings for the allegation listed above. Due to the situation surrounding the Coronavirus Disease 2019 (COVID-19) and to implement mitigation measures, today’s complaint investigation was conducted with the facility administrator, Lesly Figuero.

On 11/06/20, LPA Williams toured the facility via Face Time with the administrator . LPA Williams obtained resident and staff rosters. LPA Williams emailed Administrator Lesly Figueroa a hard copy via email for signature of the Complaint Investigation Report LIC9099.

On 03/02/21, LPA Jones toured the facility via facetime and interviewed staff and residents.

The allegation revealed the following: For allegation: Residents' are receiving insulin injections by unqualified individuals. Its being alleged non-staff and non-licensed staff inject insulin on residents. On 03/02/21,

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Angela J Kendrick	TELEPHONE: (323) 629-7815
LICENSING EVALUATOR NAME: Jennifer Jones	TELEPHONE: (323) 516-3833
LICENSING EVALUATOR SIGNATURE:	DATE: 03/14/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/14/2021

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 6

Control Number 11-AS-20201029150702

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: PALMCREST GRAND RESIDENCE	FACILITY NUMBER: 198602069
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/14/2021

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 03/19/2021 Section Cited CCR 87629(b)(1)	1 2 3 4 5 6 7	Ensuring that injections are administered by an appropriately skilled professional should the resident require assistance. This requirement is not met as evidence by: Based on resident and staff interviews, S2 is administer insulin injections to residents	1 2 3 4 5 6 7	The administrator will review regulation 87629 regarding the appropriate skilled professional to administer injections. The administer will submit documentation that she read the regulation and how she will comply moving forward. The administer will send documentation by the POC due date.
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Angela J Kendrick	TELEPHONE: (323) 629-7815
LICENSING EVALUATOR NAME: Jennifer Jones	TELEPHONE: (323) 516-3833
LICENSING EVALUATOR SIGNATURE:	DATE: 03/09/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/09/2021

LIC9099 (FAS) - (06/04)

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Control Number 11-AS-20201029150702

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: PALMCREST GRAND RESIDENCE	FACILITY NUMBER: 198602069
	VISIT DATE: 03/14/2021

NARRATIVE

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LPA Jones interviewed R1- R9. Residents 1-3 stated they are receiving assistance with insulin injections by LVNs and staff 2. Residents 4-9 stated they are not taking insulin. LPA Jones interviewed staff 1-9. Staff 2 denied the allegation and stated that she only assist with insulin by drawing the insulin in the syringe. Staff 9 stated that staff 2 does assist with insulin and the remaining staff said they do not know who is administering insulin to residents because they are not in the rooms during the medication is time. During document review, LPA did not observe any documentation that staff 2 is able to administer insulin.

Based on LPAs observations and interviews which were conducted and the records that were reviewed, the preponderance of evidence standard has been met, therefore the above allegation is found to be substantiated. California Code of Regulations, Title 22, Division (6) and Chapter (8) are being cited on the attached LIC 9099D.

A telephonic exit interview was conducted with Administrator Lesly Figueroa and a hard copy was provided via email for signature.

SUPERVISOR'S NAME: Angela J Kendrick	TELEPHONE: (323) 629-7815
LICENSING EVALUATOR NAME: Jennifer Jones	TELEPHONE: (323) 516-3833
LICENSING EVALUATOR SIGNATURE:	DATE: 03/14/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/14/2021

LIC9099 (FAS) - (06/04)

Page: 3 of 6

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
10/29/2020 and conducted by Evaluator Jennifer Jones

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20201029150702

FACILITY NAME:	PALMCREST GRAND RESIDENCE		FACILITY NUMBER:	198602069
ADMINISTRATOR:	STREICHER, RACHEL		FACILITY TYPE:	740
ADDRESS:	3503 CEDAR AVENUE		TELEPHONE:	(562) 595-4551
CITY:	LONG BEACH	STATE: CA	ZIP CODE:	90807
CAPACITY:	262	CENSUS: 107	DATE:	03/14/2021
		UNANNOUNCED	TIME BEGAN:	11:00 AM
MET WITH:	Lesly Figueroa, Administrator		TIME COMPLETED:	12:00 PM

ALLEGATION(S):

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Resident's are not treated with dignity and respect.
Staff falsified resident's medical documents.
Resident's medication went missing
Residents' money went missing
Uncleared staff working at the facility
Staff are not trained
Facility has pests

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Jennifer Jones initiated a complaint investigation and delivered findings for the allegation listed above. Due to the situation surrounding the Coronavirus Disease 2019 (COVID-19) and to implement mitigation measures, today’s complaint investigation was conducted with the facility administrator, Lesly Figuero.

On 11/06/20, LPA Williams toured the facility via Face Time with the administrator . LPA Williams obtained resident and staff rosters. LPA Williams emailed Administrator Lesly Figueroa a hard copy via email for signature of the Complaint Investigation Report LIC9099.

On 03/02/21, LPA Jones toured the facility via facetime and interviewed staff and residents.

The allegation revealed the following: For allegation(Resident's are not treated with dignity and respect.) It was alleged that staff are rude to residents. Residents 1-9 revealed to LPA during their interviews that

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Angela J Kendrick	TELEPHONE: (323) 629-7815
LICENSING EVALUATOR NAME: Jennifer Jones	TELEPHONE: (323) 516-3833
LICENSING EVALUATOR SIGNATURE:	DATE: 03/14/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/14/2021

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

LIC9099 (FAS) - (06/04)

Page: 4 of 6

Control Number 11-AS-20201029150702

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: PALMCREST GRAND RESIDENCE	FACILITY NUMBER: 198602069
	VISIT DATE: 03/14/2021

NARRATIVE

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staff are nice. The residents stated that they have not experienced staff being rude to them. Staff 1-7 denied the allegation and said they are always nice to the residents and never observed any of their colleagues being rude.

For allegation: (Staff falsified resident's medical documents.) It was alleged that the facility administrator is asking staff to change dates on residents’ documents and physician reports. Staff 1/administrator denied the allegation. Staff 2-7 revealed during their interview that the facility administrator has never asked them to change the dates on resident documents. Staff 2-7 stated that they have never been asked to do anything illegal or unethical by the administrator.

For allegation:(Resident's medication went missing) It was alleged that a resident in care medication was missing. LPA interviewed the resident regarding the incident the resident stated that she receives all of her medication and there has not been a time when it was missing. The remaining residents revealed during their interviews that they do not take medication, they are in charge of their own medication and/or their mediation has been late but their has not been a time when they were missing their medication.

For allegation: (Residents' money went missing) It was alleged that a resident who no longer resides at the facility had money and personal belongings missing. On 03/05/2021, LPA Brown investigated the allegation
(complaint ctrl #11-AS-20201203150256) and it was revealed that residents’ personal belongings were stated to be missing but there was insufficient evidence to prove that their belongings were stolen. On 03/02/2021, LPA Jones interviewed residents 1-9. One resident stated that her money was missing but the facility recovered it and the remaining residents stated that they have never experienced money missing.

For allegation: (Uncleared staff working at the facility) It is being alleged that unclear staff are working at the facility and providing care. LPA Jones interviewed residents 1-9 about the allegation. LPA provided the residents with the alleged unclear staff's name and all residents stated that they did not know a staff member by that name. LPA Jones interviewed staff 1-7 about the allegation. Staff 1 denied the allegation. Staff 2-7 revealed during their interviews that they do not know the alleged unclear staff member. Staff 2-7 stated they assume all staff are fingerprint cleared when they start working.

For allegation: (Staff are not trained) It is being alleged that facility staff are not properly trained. On 03/11/21, the administrator emailed LPA Jones staff training certificates and stated that all staff are trained.

SUPERVISOR'S NAME: Angela J Kendrick	TELEPHONE: (323) 629-7815
LICENSING EVALUATOR NAME: Jennifer Jones	TELEPHONE: (323) 516-3833
LICENSING EVALUATOR SIGNATURE:	DATE: 03/14/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/14/2021

LIC9099 (FAS) - (06/04)

Page: 5 of 6

Control Number 11-AS-20201029150702

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: PALMCREST GRAND RESIDENCE	FACILITY NUMBER: 198602069
	VISIT DATE: 03/14/2021

NARRATIVE

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On 03/02/21, LPA interviewed residents 1-9 about the allegation. Some of residents stated they are independent, the staff seemed to be trained and staff are doing the the best they can. Staff 2-7 revealed during their interviews that all staff are properly trained. Staff 2-7 stated they do not feel any of their colleagues are unqualified

For allegation: (Facility has pests) it is being alleged that the facility has mice. LPA interviewed resident 1-9 about the allegation. One resident stated that she saw a mouse in her room back in September and October 2020. The resident stated that the facility called an exterminator and she has not observed another mouse once the exterminator came out. The other remaining residents stated that they never observed mice in their rooms or anywhere else in the facility.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegation is unsubstantiated.

A telephonic exit interview was conducted with Administrator Lesly Figueroa and a hard copy was provided via email for signature.

SUPERVISOR'S NAME: Angela J Kendrick	TELEPHONE: (323) 629-7815
LICENSING EVALUATOR NAME: Jennifer Jones	TELEPHONE: (323) 516-3833
LICENSING EVALUATOR SIGNATURE:	DATE: 03/14/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/14/2021

LIC9099 (FAS) - (06/04)

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