198602069-9-14-2022-11-AS-JHAD-CKY7Q6-20221107205126

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198602069
Report Date: 02/09/2022
Date Signed: 09/14/2022 11:46:54 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
01/11/2022 and conducted by Evaluator Jose Calderon

COMPLAINT CONTROL NUMBER: 11-AS-20220111114958

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:	DATE:	02/09/2022
		UNANNOUNCED	TIME BEGAN:	01:59 PM
MET WITH:			TIME COMPLETED:	02:00 PM

ALLEGATION(S):

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Facility is not following COVID-19 guidelines
Residents are not being showered timely due to lack of staff
Residents are not being changed timely due to lack of staff

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Jose Calderon conducted an unannounced visit to the facility on 02/09/2022 at 01:00 PM and was greeted by Administrator (S1). LPA Calderon spoke to S1 prior to entering the facility to conduct a risk assessment. LPA Calderon explained the purpose of this visit is to deliver the findings pertaining to the above-mentioned allegations.

Licensing Program Analyst (LPA) Jose Calderon conducted an unannounced 10 day visit on 02/09/2022 approximately 01:00 PM. LPA Calderon initiated an investigation for the above-mentioned allegation and conducted a face-to-face interview with Administrator (S1) on 01/11/2022. On 01/11/2022 LPA Calderon requested copies of the following: staff and residents’ roster, SIR reports (for current complaint), physician’s report, appraisal/needs and service plan, and all medical records to include any hospital records for Resident #1 and MAR for R2 – R5. On 02/08/2022 LPA Calderon interviewed S2 – S6 for complaint and on 02/09/2022 LPA Calderon interviewed R1 – R5 for complaint for complaint. On 01/11/2022 LPA Calderon interviewed W1 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: 02/09/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/09/2022

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-20220111114958

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: 02/09/2022

NARRATIVE

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Allegation: Facility did not follow quarantine procedures for COVID-19
It is alleged that the Facility did not follow quarantine procedures for COVID-19. On 01/12/2022 witness 1 who stated that the facility was not following Covid-19 regulations and noted staff not wearing masks and other PPE while inside the facility. On 01/11/2022 and 02/08/2022 LPA Calderon interviewed S1-S6 who stated that they follow all DPH and DSS process regarding Covid-19. On 02/09/2022 LPA Calderon interviewed R1-R5 who stated that all staff wear masks and other PPE supplies while inside the facility. On 02/07/2022,02/08/2022, and 02/09/2022 LPA Calderon noted that facility was closed to guests per Long Beach Department of Health directive, that all staff wear masks, shields and gowns and there is signs all over the facility regarding the use of PPE’s. LPA Calderon did note that all guest have to sign in at the front desk, answer Covid-19 questions and have their temperature taken. LPA Calderon also noted staff and residents wear mask while inside the facility and LPA Calderon had my temperature taken and was asked Covid-19 questions.
Allegation: Residents are not being showered timely due to lack of staff. It is alleged that the Residents are not being showered timely due to lack of staff. On 01/12/2022 witness 1 who stated that the facility staff due to Covid-19 was not showering residents on a regular basis, but witness did not have any names of other residents this was happening too. On 01/11/2022 and 02/08/2022 LPA Calderon interviewed S1-S6 who stated that they follow all DPH and DSS process regarding Covid-19 and that due to Covid-19 staff are busy and somewhat backed up giving showers, but staff does have a showering schedule per floor and help resident that need showering needs based on needs and service plan. On 02/09/2022 LPA Calderon interviewed R1-R5 who stated that staff do help residents that need help showering on a weekly basis and that Covid-19 has backed up staff, but residents have no issues with the service provided. Residents state that staff are busy, but there are no staffing issues.
Allegation: Residents are not being changed timely due to lack of staff. It is alleged that the Residents are not being changed timely due to lack of staff. On 01/12/2022 witness 1 who stated that the facility due to Covid-19 was not changing residents’ diapers on time, but witness did not have any names of residents this was happening too. On 01/11/2022 and 02/08/2022 LPA Calderon interviewed S1-S6 who stated that they follow all DPH and DSS process regarding Covid-19 and that due to Covid-19 staff are working harder for all residents, but residents that need diaper change or help changing their diaper are given help every day and staff does keep records of changing of diapers for residents based on the resident needs and service plan. On 02/09/2022 LPA Calderon interviewed R1-R5 that they do not need to wear diapers, but that they do have residents/friends that have their diaper changed daily and have not heard of any issues with service from staff.

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Jose Calderon	TELEPHONE: (323) 213-1153
LICENSING EVALUATOR SIGNATURE:	DATE: 02/09/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/09/2022

LIC9099 (FAS) - (06/04)

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Control Number 11-AS-20220111114958

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: 02/09/2022

NARRATIVE

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Based on interviews, observations, and supporting documentation, the preponderance of evidence standard has not been met; therefore, the allegation of Facility did not follow quarantine procedures for COVID-19, Residents are not being showered timely due to lack of staff, Residents are not being changed timely due to lack of staff is found to be UNSUBSTANTIATED.

A telephonic exit interview was conducted with Administrator Peggy Clark, and a hard copy was provided in person for records.

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Jose Calderon	TELEPHONE: (323) 213-1153
LICENSING EVALUATOR SIGNATURE:	DATE: 02/09/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/09/2022

LIC9099 (FAS) - (06/04)

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