198602069-5-20-2022-11-AS-JHAD-CERVK9-20220525162957

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198602069
Report Date: 02/09/2022
Date Signed: 05/20/2022 09:29:40 AM

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
02/02/2022 and conducted by Evaluator Jose Calderon

COMPLAINT CONTROL NUMBER: 11-AS-20220202153526

FACILITY NAME:	PALMCREST GRAND RESIDENCE		FACILITY NUMBER:	198602069
ADMINISTRATOR:	PEGGY CLARK		FACILITY TYPE:	740
ADDRESS:	3503 CEDAR AVENUE		TELEPHONE:	(562) 595-4551
CITY:	LONG BEACH	STATE: CA	ZIP CODE:	90807
CAPACITY:	262	CENSUS: 113	DATE:	02/09/2022
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	ADMINSTRATOR PEGGY CLARK		TIME COMPLETED:	09:59 AM

ALLEGATION(S):

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Facility does not properly bathe resident
Facility does not meet resident's incontinence needs

INVESTIGATION FINDINGS:

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On 02/09/2022 around 02:00 PM Licensing Program Analyst (LPA) Jose Calderon initiated a complaint investigation to deliver the investigation findings for the allegation listed above. Today’s complaint investigation was conducted face to face with Administrator Peggy Clark.

The Investigation consisted of the following: On 02/08/2022 LPA Jose Calderon interviewed Administrator Peggy Clark(S1) and conducted a tour of the physical plant. On 02/08/2022 LPA Calderon requested copies of the following: Staff and Resident Roster, Needs and Service plan, Physician Report, medical reports for past 3 months, Medication list, SIR reports for 3 months, admission agreement. On 02/02/2022 LPA Calderon interviewed R1 and on 02/07/2022 and 02/08/2022 LPA Calderon interviewed S1-S6. On 02/07/2022 LPA Calderon interviewed R1-R10

The investigation revealed the following:

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Jose Calderon	TELEPHONE: (323) 213-1153
LICENSING EVALUATOR SIGNATURE:	DATE: 02/09/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/09/2022

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-20220202153526

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: 02/09/2022

NARRATIVE

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Allegation: Facility does not properly bathe resident

It is alleged Facility does not properly bathe resident. On 02/07/2022 LPA Calderon Interviewed R1 who stated that the facility staff had either missed or refused to give R1 a bathe and that R1 had gone for 9 days without someone cleaning his body. R1 states that staff are not happy with R1 and are getting R1 back due to making so many complaints. R2 stated that R2 takes a shower by R2 and does not need any help from staff. On 02/08/2022 LPA Calderon reviewed all facility paperwork for R1 to include the admission agreement, needs and service, physician report, MAR which all support that facility can help R1 bathe but that R1 is very capable of clean R1 except for hard to reach places. On 02/08/2022 LPA Calderon interviewed S1-S6 who state that R1 asked the female staff to clean and touch his private parts which they refused, staff states that they will not go into R1 room unless there is another staff member and currently only man staff helps R1 bathe.

Allegation: Facility does not meet resident's incontinence needs.

On 02/02/2022 LPA Calderon Interviewed R1 who stated that R1 had gone to the bathroom in R1 bed many times and that staff refuses to change R1 diaper or the sheets in his bed and that due to staffing issues and that staff is getting R1 back for making so many complaints therefore R1 needs are not being met. On 02/08/2022 LPA Calderon reviewed facility paperwork to include the admission agreement, needs and service plan, physician report all supports that R1 needs some help with R1 incontinence needs, but can go to the bathroom. On 02/07/2022 LPA Calderon interviewed S1-S6 who state that when R1 needs to have R1 diaper or sheets changed they do so as many times as needed. Staff state that they might have to take some time to get to his room on a night shift but there is no way they would go 9 days without changing is bed sheets or his diaper.

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.

An exit interview was conducted with Administrator Peggy Clark, and a hard copy was provided for records.

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Jose Calderon	TELEPHONE: (323) 213-1153
LICENSING EVALUATOR SIGNATURE:	DATE: 02/09/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/09/2022

LIC9099 (FAS) - (06/04)

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