198602069-6-23-2022-11-AS-JHAD-CK5MVM-20221012095657

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198602069
Report Date: 10/19/2021
Date Signed: 06/23/2022 10:34:38 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
06/17/2021 and conducted by Evaluator Jose Calderon

COMPLAINT CONTROL NUMBER: 11-AS-20210617100756

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:	10/19/2021
		UNANNOUNCED	TIME BEGAN:	12:00 PM
MET WITH:	ADMINISTRATOR PEGGY CLARK		TIME COMPLETED:	01:00 PM

ALLEGATION(S):

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Staff did not respond to communications by resident’s responsible person

INVESTIGATION FINDINGS:

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On 10/19/2021 around 1:00 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 06/21/2021 LPA Calderon interviewed witness for complaint. On 06/21/2021 LPA Calderon received and reviewed email paperwork from witness. On 06/22/2021 LPA Calderon interviewed S1-S7 for complaint and on 07/01/2021 LPA Calderon interviewed R2-R10 for complaint. On 07/02/2021 LPA Calderon received and reviewed needs and service plan, physician report for R1. LPA Calderon and Administrator (S1) and conducted a tour of the physical plant.

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: 10/18/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/18/2021

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-20210617100756

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: 10/19/2021

NARRATIVE

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Allegation: Staff did not respond to communications by resident’s responsible person.
It is alleged that Staff did not respond to communications by resident’s responsible person. On 06/21/2021 LPA Calderon interviewed witness for complaint who states that W1 had called and emailed the administrator regarding R1 care with no response. On 07/02/2021 LPA Calderon received and reviewed emails from W1 regarding emails sent to S1 for more information on R1. There was proof via email’s that S1 had attempted to communicate with W1 regarding R1 care while in the facility. On 06/22/2021 LPA Calderon interviewed S1-S7 for complaint all stated that if there is any issue with a resident the staff calls, emails the family of resident, and if they receive any communication from family they pass along the message to the administrator for a response. On 07/02/2021 LPA Calderon interviewed R2-R10 for complaint all stated that staff did respond to their family phone calls or emails and they do not have any issues with staff. Residents stated that their family normally calls them via personal cell phone and any issues communications with family they advise staff who makes contact.

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 face to face 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: 10/18/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/18/2021

LIC9099 (FAS) - (06/04)

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