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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198602069
Report Date: 08/30/2022
Date Signed: 08/30/2022 02:50:02 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 Troy Agard
PUBLIC
COMPLAINT CONTROL NUMBER: 11-AS-20220822161346
FACILITY NAME:PALMCREST GRAND RESIDENCEFACILITY NUMBER:
198602069
ADMINISTRATOR:PEGGY CLARKFACILITY TYPE:
740
ADDRESS:3503 CEDAR AVENUETELEPHONE:
(562) 595-4551
CITY:LONG BEACHSTATE: CAZIP CODE:
90807
CAPACITY:262CENSUS: 118DATE:
08/30/2022
UNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Peggy Clark sTIME COMPLETED:
03:00 PM
ALLEGATION(S):
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Facility does not follow COVID-19 protocol
Facility does not allow resident to have visits
Facility requires visitors to make appointments
Facility does not allow resident to have phone calls
Staff do not answer facility phone
INVESTIGATION FINDINGS:
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On 08/29/2022, Licensing Program Analyst (LPA) Troy Agard initiated a complaint investigation to address the allegations listed above. LPA Agard met with Peggy Clark, Administrator and explained the purpose of this visit is to gather information for the complaint and deliver findings.

The investigation consisted of the following: LPA Agard conducted a tour of the facility grounds. The facility is a 2-story building, that is licensed for a capacity of 262. The Memory Care Unit is located on the second floor of the second building and consists of 22 bedrooms, kitchen/dining room, a common area used for activities and a closed patio also located on the second floor. LPA interviewed staff, residents, a witness, and reviewed records. LPA Agard requested the following documents, which were received at the time of visit: 1) a copy of the staff roster, 2) a copy of the resident roster, 3) needs and services plans for R1, 4) physician report for R1, 5) Incident reports in the past 30 days, 6) any correspondents from Department of Public Health. 7) any relevant information to this complaint.

On 08/30/2022, LPA conducted a subsequent visit to delivered findings.
Cont. on 9099C
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Ulysses CoronelTELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Troy AgardTELEPHONE: (323) 400-7109
LICENSING EVALUATOR SIGNATURE:

DATE: 08/30/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/30/2022
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 5
Control Number 11-AS-20220822161346
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: 08/30/2022
NARRATIVE
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The investigation revealed the following: Regarding the allegation: Facility does not follow COVID-19 protocol. “It’s being alleged that some staff did not offer masks to the residents.” On 08/29/2022 LPA interviewed 7 out of 62 staff. 7 out of 7 denied the allegation to be true. S1 states, “staff are not refusing to wear a mask and the residents wear a mask if they can tolerate it.” S2 states, “we do follow Covid protocol, Long Beach Department of Health came in and showed us what to do and how to properly track. Staff are compliant in wearing mask. Residents are encouraged to wear one, but we can’t force them. “S3 states, “yes, we try as best we can to follow Covid protocol. I even give rapid test to people that come in. Most of the staff are compliant.” S4 states, “I think that everything is okay. We still wear mask. They ask for vaccinations and some of the residents wear a mask but not the ones in memory care. It’s hard for them.” S5 states, “they give us gloves, gowns, and face covers. Staff wear their mask all the time. So, I think we are following covid protocol.”

During interviews with residents, LPA interviewed 10 out of 118, 9 out of 10 denied the allegation to be true. R1 was unable or unsure how to answer the question. R2 states, “I think they are from what I can see. I don’t know everything about what’s going on but yes. The staff are wearing mask, I wear a mask.” R3 states, I came here last year, and they are always telling me to wear my mask and they do test once per week.” R5 states, “I wear a mask.” R8 states, “I don’t think that’s true and from what I see they are doing a good job. As far as I notice staff are wearing mask and so are the residents. During an interview with a witness, W1 states, “I visit often, and everyone is wearing a mask. Some residents like R1 have to be reminded because they forget.”

Regarding the allegation: Facility does not allow resident to have visits. It’s being alleged that a resident can only have a person visit once per month. 7 out of 7 denied the allegation to be true. S1 states, “we are allowing visitors at any time.” S2 states, “we are allowing visitation. No one is being denied or only allowed to come once per month.” S3 states, “that’s false the residents have visitors all the time.” S4 states, “during covid we couldn’t allow visits, but it was for that reason. Now it’s no problem.” S6 states, “family and friends are allowed to come visit, there is no restrictions that I know of for anyone.”

During interviews with residents, 9 out of 10 denied the allegation to be true. R1 was unable or unsure how to answer the question. R2 states, “I have visitors come and they have never been refused.” R3 states, “I have visitors. My daughter, sister, my daughter’s husband and my grandkids come to see me all the time.” R4

Cont on 9099C

SUPERVISOR'S NAME: Ulysses CoronelTELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Troy AgardTELEPHONE: (323) 400-7109
LICENSING EVALUATOR SIGNATURE:

DATE: 08/30/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/30/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 11-AS-20220822161346
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: 08/30/2022
NARRATIVE
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states, “I notice family members and friends come frequently to visit their loved ones. I don’t really have any because my family lives out of state.” R6 states, “we are allowed to have visitors. My daughter comes to see me.” R7 states, “we are allowed to have visitors. My son comes every weekend and brings my grandchild.” During an interview with a witness, W1 states, “I’m able to visit the facility without any restrictions. I did ask the facility not to allow my relative into the building but instead they opted to notify me.”

Regarding the allegation: Facility requires visitors to make appointments. It’s being alleged that the facility requires a visitor to make an appointment before visiting. 6 out of 7 denied the allegation to be true. Citing this was only the protocol during a covid outbreak and was not mandatory but encouraged. 1 staff was unsure. S1 states, “the health department closed us to the public. We couldn’t have admissions; Visitors are no longer required to make appointments. When we had the outbreak, we had that in place. Just so the facility wasn’t overcrowded.” S2 states, “. In memory care there are shared rooms, so we have people visit on the patio. It’s not so much of an appointment but just to let us know they were coming to make sure there was enough space and to be able to get the residents down to the patio area. S3 states, “We encourage appointments but mainly when we have positives because we have to test and check cards. At this moment, it’s not a requirement but when we are in a lockdown, it’s a requirement. S5 states, “we asked them to call ahead but that was only because we don’t want a lot of people in one space. It’s not required, we just ask. S7 states, “I don’t know if visitors are required to make appointments”

During interviews with residents, 9 out of 10 either denied or could not confirm the allegation to be true. Citing this was only the protocol during a covid outbreak. R1 was unable or unsure how to answer the question. R2 states, “my friend comes but she doesn’t come in my room. My friend shows up. She doesn’t have to make an appointment to see me.” R3 states, “only during the lock down, they needed to make appointments.” R5 states, “I don’t know if appointments need to be made when people come to visit.” R7 states, “my son does not have to make an appointment to come see me.” R8 states, “I have been asked to have dates and have it arranged but that was so we didn’t have too many people at once. I think that was the past but I’m not sure. I don’t think my visitors have to make appointments. I might notify the staff but that’s me.” During an interview with a witness, W1 states, “I still make an appointment although I may not have to.”

Regarding the allegation: Facility does not allow resident to have phone calls. Its being alleged that the facility is not giving residents access to the phone. 7 out of 7 denied the allegation to be true. S1 states, “of course, residents can use the phone. It’s in the lobby. The staff don’t monitor the phone. Its right at the front.” Cont. on 9099C

SUPERVISOR'S NAME: Ulysses CoronelTELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Troy AgardTELEPHONE: (323) 400-7109
LICENSING EVALUATOR SIGNATURE:

DATE: 08/30/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/30/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 11-AS-20220822161346
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: 08/30/2022
NARRATIVE
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S2 states, “There is a public phone in the lobby and most of residents have a cellphone. There may be a resident that stays on the phone to long, but the phone is always available. It’s in the lobby.” S4 states, “That’s not true, residents have their own phone in the front. There are some caregivers that will give their phones up for them to use as well.”

During interviews with residents, 9 out of 10 either denied or could not confirm the allegation to be true. R1 was unable or unsure how to answer the question. R2 states, that’s not true we have a house call. Who would even say that? That’s not true.” R3 states, “Oh yes, we are able to have phone calls. I can use the phone in the lobby. It’s been a while, but I also have a cell phone.” R5 & 6 states, “I have my own phone, so I don’t use that one.” R10 states, “I can call out and receive calls without issue.” During an interview with a witness, W1 states, “R1 doesn’t even know how to use a phone so that doesn’t seem correct. They don’t remember.”

Regarding the allegation: Staff do not answer facility phone. “It’s being alleged that staff do not answer calls, nor do they return voice messages.” 7 out of 7 denied the allegation to be true. “If we hear the phone, we answer it. There’s someone at the desk 24/ 7.” S3 states, “That’s not true, I answer and transfer calls all the time. S5 states, “We don’t get calls at the facility personally but the person at the front desk answers the calls and send them to us.” S7 states, “yes, the front desk answers the phone because we get the calls transferred all day long.”

During interviews with residents, 9 out of 10 either denied or could not confirm the allegation to be true. R1 was unable or unsure how to answer the question. R3 states, “I don’t know if staff answer the phone, but I mean they call the intercom when we have a call that’s how they called me to come down.” R5, “I don’t know if they answer the phone. I don’t call the front desk.” R8 states, “in the front office they do answer the phone and they direct the call where it needs to go.” R10 states, “I always see the staff answering the phone and I always get my calls.” During an interview with a witness, W1 states, “they always answer the phone for me.”



During a record review, LPA reviewed the following records: a staff roster not dated. All staff interviewed matches with roster. A resident roster dated August 2022. All residents interviewed matches with the roster. A mitigation plan from August 2021 which states in section 5, “Persons in care are wearing face covering (as they are able to tolerate.) Which means residents will be encouraged to wear a mask but not mandated. Correspondents from Long Beach Department of health dated July 19, 2022 that indicates the facility was in
Cont. on 9099C
SUPERVISOR'S NAME: Ulysses CoronelTELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Troy AgardTELEPHONE: (323) 400-7109
LICENSING EVALUATOR SIGNATURE:

DATE: 08/30/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/30/2022
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 11-AS-20220822161346
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: 08/30/2022
NARRATIVE
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the midst of an outbreak. A letter dated August 11, 2022 indicating the conclusion of the outbreak. At time of visit, LPA was screened for covid symptom at facility entrance during both visits. LPA observed staff and residents wearing a face covering as well as visitors being screened. LPA reviewed a request dated 08/28/2022 sent by a family member requesting denial of visitation of another family member due to safety concerns and family dynamics.

Based on LPA’s observation, interviews conducted, and record review, the preponderance of evidence standard has not been met. Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated.


An exit interview was conducted, and a copy of the report was given.
SUPERVISOR'S NAME: Ulysses CoronelTELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Troy AgardTELEPHONE: (323) 400-7109
LICENSING EVALUATOR SIGNATURE:

DATE: 08/30/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/30/2022
LIC9099 (FAS) - (06/04)
Page: 5 of 5