198602069-8-29-2022-11-AS-MVAO-CJQQSY-20220929122618

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198602069
Report Date: 08/29/2022
Date Signed: 08/29/2022 01:41:20 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
08/22/2022 and conducted by Evaluator Jose Calderon

COMPLAINT CONTROL NUMBER: 11-AS-20220822115203

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: 118	DATE:	08/29/2022
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	ADMINISTRATOR PEGGY CLARK		TIME COMPLETED:	01:45 PM

ALLEGATION(S):

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Staff did not notice a change in residents medical condition
Staff did not seek medical attention in a timely manner
Staff can not communicate effectively with residents

INVESTIGATION FINDINGS:

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On 08/29/2022 around 09:00 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 (S1).

The Investigation consisted of the following: On 08/29/2022 LPA Calderon interviewed (S1) and conducted a tour of the physical plant. LPA Calderon obtained copies of Staff and Resident rosters, Needs and Service Plan, Pre-Placement Appraisal, Physicians Report for R1 and any SIR reports for R1, log in sheet, call light log and physician report for W1. On 08/23/2022 LPA Calderon interviewed W1 regarding complaint and R1 for complaint. On 08/29/2022 LPA Calderon interviewed R2-R10 for complaint on 08/29/2022 LPA Calderon interviewed S1-S4 for complaint.
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: 08/29/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/29/2022

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-20220822115203

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: 08/29/2022

NARRATIVE

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Allegation 1: Staff did not notice a change in residents’ medical condition. On 08/29/2022 LPA Calderon interviewed W1 who states R1 had gone to the beach and returned having medical issues. W1 states that staff refuse to provide medical care timely. On 08/23/2022 LPA Calderon interviewed R1 who states staff did not notice R1 change in medical condition and did not help R1 with R1 medical needs. On 08/29/2022 LPA Calderon interviewed R2-R10 who state they have no issues with staff medical services and staff does not changes in residents’ medical condition. On 08/29/2022 LPA Calderon interviewed S1-S4 who state that staff is trained to see changes in residents’ medical condition and there were no medical issues with R1 when seen by staff. On 08/29/2022 LPA Calderon reviewed R1 medical reports, there is no hospital report regarding R1 medical evaluation

Allegation 2: Staff did not seek medical attention in a timely manner. On 08/23/2022 LPA Calderon interviewed W1 who states that staff refused to allow R1 to use a wheelchair and did not respond to the call light when W1 and staff pushed the button. On 08/23/2022 LPA Calderon interviewed R1 who states that staff did not allow for the use of a wheelchair and did not show up when the call light button was pushed by W1. On 08/29/2022 LPA Calderon interviewed R2-R10 who state when they call for medical services staff shows up on time and in most times less then 5 minutes. On 08/29/2022 LPA Calderon interviewed S1-S4 who state that they respond to residents needs timely. On 08/29/2022 LPA Calderon reviewed the call light log. Call log states that staff responded within 10 minutes of the call made by W1.

Allegation 3: Staff cannot communicate effectively with residents. On 08/23/2022 LPA Calderon interviewed W1 who states that staff does not communicate with residents and that on the date of complaint staff did not respond to W1 communication regarding R1 medical condition. On 08/23/2022 LPA Calderon interviewed R1 who state that staff did not respond to W1 calls and did not understand what R1 was telling them of R1 changing medical condition. On 08/29/2022 LPA Calderon interviewed R2-R10 who state no issues with communications with staff regarding their medical needs. On 08/29/2022 LPA Calderon interviewed S1-S4 who state no issues regarding communication with residents and their medical needs.

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 exit interview was conducted with Administrator S1, and a hard copy was provided.

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Jose Calderon	TELEPHONE: (323) 213-1153
LICENSING EVALUATOR SIGNATURE:	DATE: 08/29/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/29/2022

LIC9099 (FAS) - (06/04)

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