198602069-3-5-2021-11-AS-MCAA-BZLVLV-20210330163232

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198602069
Report Date: 03/05/2021
Date Signed: 03/05/2021 04:53:24 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
12/03/2020 and conducted by Evaluator Erik Brown

COMPLAINT CONTROL NUMBER: 11-AS-20201203150256

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: 108	DATE:	03/05/2021
		UNANNOUNCED	TIME BEGAN:	09:31 AM
MET WITH:	Lesly Figueroa, Administrator		TIME COMPLETED:	12:30 PM

ALLEGATION(S):

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Resident’s personal belongings were stolen

INVESTIGATION FINDINGS:

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On this date, Licensing Program Analyst (LPA) Erik Brown conducted a subsequent tele-visit to obtain additional information to support unsubstantiated findings. Due to the situation surrounding the Coronavirus Disease 2019 (COVID-19), and to implement mitigation measures, today’s complaint investigation was conducted telephonically with Lesly Figueroa, the facility Administrator.

During the initial telephonic visit on 12/4/2020, LPA conducted a virtual interview and a tour of the facility with the Administrator. A request for copies of a current staff/resident roster, (R1's) ISP/ pre-placement appraisal, admissions agreement, and inventory of personal items to be sent to LPA via email by 12/8/20 for review. LPA also interviewed, Staff #1-3 and Residents #1-2.

Report continued on LIC9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Michael Cava	TELEPHONE: (323) 400-7397
LICENSING EVALUATOR NAME: Erik Brown	TELEPHONE: (747) 230-2283
LICENSING EVALUATOR SIGNATURE:	DATE: 03/05/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/05/2021

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-20201203150256

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: 03/05/2021

NARRATIVE

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During the visit on 12/7/2020, LPA Brown interviewed, Staff #3-6 and Residents #3-10 regarding the complaint allegation.

During the previous visit on 2-8-2021, LPA Brown conducted telephonic investigation and discussed findings with the Administrator.

The investigation revealed the following for allegations:

(Resident’s personal belongings were stolen)

On this date, LPA Brown conducted further interviews with residents. LPA interviewed residents #11-15 (R11-R15) regarding the complaint allegation. According to today’s interviews with residents, along with the interviews conducted during previous visits with residents and staff, although some residents’ personal belongings were stated to be missing, there was insufficient evidence to prove that their belongings were stolen.

Based on LPA Brown’s observations, the records that were reviewed (Pre-Placement Appraisal, Resident Appraisal, Resident Personal Property And Valuables, Admission Agreement) and the interviews that were conducted, 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.

A telephonic exit interview was conducted with Administrator Lesly Figueroa, and an electronic copy was provided via email for signature.

SUPERVISOR'S NAME: Michael Cava	TELEPHONE: (323) 400-7397
LICENSING EVALUATOR NAME: Erik Brown	TELEPHONE: (747) 230-2283
LICENSING EVALUATOR SIGNATURE:	DATE: 03/05/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/05/2021

LIC9099 (FAS) - (06/04)

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