198602069-5-5-2021-11-AS-JHAD-C2VVY7-20210510165040

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198602069
Report Date: 04/05/2021
Date Signed: 05/05/2021 02:45:57 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
07/16/2020 and conducted by Evaluator Ana Soto

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20200716125111

FACILITY NAME:	PALMCREST GRAND RESIDENCE		FACILITY NUMBER:	198602069
ADMINISTRATOR:	STREICHER, RACHEL		FACILITY TYPE:	740
ADDRESS:	3503 CEDAR AVENUE		TELEPHONE:	(562) 595-4551
CITY:	LONG BEACH	STATE: CA	ZIP CODE:	90807
CAPACITY:	262	CENSUS: 109	DATE:	04/05/2021
		UNANNOUNCED	TIME BEGAN:	02:00 PM
MET WITH:	Lesly Figueroa, Administrator		TIME COMPLETED:	04:30 PM

ALLEGATION(S):

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Resident not granted access to a functional telephone
Resident room moved without responsible party's consent
Failed to produce resident records per request of responsible party

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Ana Soto conducted a subsequent complaint investigation to deliver findings and decisions for the allegations listed above. Due to the situation surrounding the Corona virus Disease 2019 (COVID-19), and to implement mitigation measures, today’s complaint investigation was conducted telephonically with Lesli Figueroa, the facility administrator.

The investigation consisted of following: Interviews and Record reviews. On 03/23/21, LPA Soto interviewed Administrator Lesly Figueroa, S#3 & S#4, and R#1 - R#9. LPA Soto obtained the following documents: Face sheets, Admission agreement, MARS logs for February and March, Pre-Appraisals, Physician's Report for R#1, R#5, R#8. Hospice file for R#1, and Needs /services plan for R#5 & R#8.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Ana Soto	TELEPHONE: (323) 383-8284
LICENSING EVALUATOR SIGNATURE:	DATE: 04/05/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/05/2021

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-20200716125111

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: 04/05/2021

NARRATIVE

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Based on the LPA's investigation, the investigation revealed the following.

For Allegation #1 – Resident not granted access to a functional telephone. Interviews with Administrator, staff, and residents they all stated that the phone is always accessible to the residents 24hrs a day 7 days week. LPA Soto toured the facilities lobby and virtually seen phone located by the receptionist area accessible to the residents. The interviews and LPA Soto virtual tour did not concur with the above allegation.

Allegation #2 - Resident room moved without responsible party's consent. The interviews with Administrator and staff, they all stated that the residents are not moved without prior consent of the responsible party for the resident. Interviews with residents #2, #3, #4, #5, #8, & #9, stated that they have never been moved rooms for any reason. R#1 could not verify or deny statements of being moved rooms without consent, due to her neurological disorder. LPA Soto reviewed R#1 file, could not find any information, if R#1 was moved from her room to another room without consent from responsible party. Responsible party for R#1 could not provide evidence that R#1 was moved without their permission. The interviews and record reviews did not concur with the above allegation.

Allegation #3 - Failed to produce resident records per request of responsible party. The interviews with Administrator and staff, stated that they always try to respond and provide any documents requested by resident or responsible party within 48 hrs of the request. The interviews with resident, stated that they believe if they requested any documents the facility, the facility would give it to them. The interviews conducted did not concur with the above allegation.

Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are unsubstantiated

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

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Ana Soto	TELEPHONE: (323) 383-8284
LICENSING EVALUATOR SIGNATURE:	DATE: 04/05/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/05/2021

LIC9099 (FAS) - (06/04)

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