198602069-8-19-2021-11-AS-JHAD-CF72BU-20220607171542

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198602069
Report Date: 08/19/2021
Date Signed: 08/19/2021 03:23:42 PM

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
05/19/2021 and conducted by Evaluator Jose Calderon

COMPLAINT CONTROL NUMBER: 11-AS-20210519090545

FACILITY NAME:	PALMCREST GRAND RESIDENCE		FACILITY NUMBER:	198602069
ADMINISTRATOR:	LESLY FIGUEROA		FACILITY TYPE:	740
ADDRESS:	3503 CEDAR AVENUE		TELEPHONE:	(562) 595-4551
CITY:	LONG BEACH	STATE: CA	ZIP CODE:	90807
CAPACITY:	262	CENSUS: 116	DATE:	08/19/2021
		UNANNOUNCED	TIME BEGAN:	11:00 AM
MET WITH:	Administrator Peggy Clark		TIME COMPLETED:	12:00 PM

ALLEGATION(S):

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Facility staff mismanage medications.
Facility does not have adequate staffing.

INVESTIGATION FINDINGS:

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On 08/19/2021 around 10:00 AM 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 05/25/2021 LPA Jose Calderon interviewed Administrator Lesly Figueroa(S1) and conducted a tour of the physical plant. On 5/25/2021 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 records for R1. On 6/07/2021 LPA Calderon interviewed S2-S6 and attempted to interview R1-R10 in the (MC) memory care unit but was unable to obtain any interviews. On 06/07/2021 received and reviewed R1 facility paperwork.

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: 08/18/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/18/2021

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-20210519090545

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: 08/19/2021

NARRATIVE

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The investigation revealed the following:

Allegation: Facility staff mismanage medications.
It is alleged Facility staff mismanage medications. On 05/25/2021 LPA Jose Calderon interviewed Administrator (S1) who stated S1 staff did not mismanage medications for R1. On 5/25/2021 LPA Calderon requested copies of the following: Needs and Service plan, Physician Report, medical reports for past 3 months, Medication list, SIR reports for 3 months records for R1. LPA Calderon reviewed MAR and did not observe medication discrepancy at this time of visit. On 6/07/2021 LPA Calderon interviewed S2-S6 who stated that the Med-Techs keep records of what they give to residents daily. On 05/31/2022 LPA Calderon interviewed R2 - R9 and residents did not state that staff was mismanaging their medication and they were happy with the service given.

Allegation: Facility does not have adequate staffing.
It is alleged Facility does not have adequate staffing. On 05/25/2021 LPA Jose Calderon interviewed Administrator (S1) who stated there are enough employees, but some staff take vacation, but this does not effect service of the residents. On 5/25/2021 LPA Calderon requested copies of the following: Staff personal records, time sheets. Record received did not note any staffing issue or a mismanagement of staff. On 6/07/2021 LPA Calderon interviewed S2-S6 who stated that they were not short staffed. On 05/26/2021 LPA Calderon interviewed R1 who stated there were no staffing issues.. On 05/31/2022 LPA Calderon interviewed R2 - R9 all residents states there is enough staff to provide services to all residents in their care.

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 via email for records.

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Jose Calderon	TELEPHONE: (323) 213-1153
LICENSING EVALUATOR SIGNATURE:	DATE: 08/18/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/18/2021

LIC9099 (FAS) - (06/04)

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