198602069-5-12-2021-11-AS-JHAD-C34SMF-20210517135949

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198602069
Report Date: 04/29/2021
Date Signed: 05/12/2021 04:05:49 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
12/21/2020 and conducted by Evaluator Ulysses Coronel

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20201221140355

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: 117	DATE:	04/29/2021
		UNANNOUNCED	TIME BEGAN:	09:48 AM
MET WITH:	Lesly Figueroa		TIME COMPLETED:	05:00 PM

ALLEGATION(S):

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Resident being called inappropriate names by another resident.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Ulysses Coronel initiated a complaint investigation for the allegations listed above. Due to the situation surrounding the Coronavirus Disease 2019 (COVID-19), and to implement mitigation measures, today’s complaint investigation was conducted telephonically with Lesly Figueroa, the facility administrator.

The investigation consisted of the following: On 12/21/2020 LPA Coronel conducted video call which consisted of a review of physical plant and interviews with the administrator and resident R1. The LPA requested of facility and residents R1 and R2’s records. On 04/29/2021 LPA interviewed the administrator 7 staff and 10 out of 117 residents. On 04/29/2021 LPA conducted reviews of regional office, facility and resident records.

The investigation revealed the following: On 12/21/2020 R1 stated that “R2 has been bothering me calling me names like queer, gay and n-word since February (2020) and I have been telling staff about it, but nothing has been done about it.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Ulysses Coronel	TELEPHONE: (951) 212-8917
LICENSING EVALUATOR SIGNATURE:	DATE: 04/29/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/29/2021

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-20201221140355

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: 04/29/2021

NARRATIVE

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On 04/29/2021 R2 stated that “R1 has been making complaints against me and even called the police, it’s happened so much that a lot of people just don’t even pay attention anymore.” R3 stated “R2 always calls R1 names, it has been happening for quite some time now.” Staff S1 stated “It seems that though the problem has already started, before I started working here years now, the previous Administrator has already made reports about it.” The administrator stated “It’s been going back and forth with these particular residents (R1 and R2) even before my time." On 04/29/2021 LPA reviewed R1’s Individual Service Plan dated 01/26/2021, LPA did not observe any interventions made or planned about R1’s concerns about being verbally abused by another resident on R1’s socialization and emotional needs. Regarding the allegation: “Resident being called inappropriate names by another resident.” Based on LPAs observations and interviews which were conducted and the records that were reviewed, the preponderance of evidence standard has been met, therefore the above allegation is found to be substantiated. California Code of Regulations, Title 22, Division 6 and Chapter 8 are being cited on the attached LIC 9099D.

Appeals rights and a hard copy was provided via email for signature.

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Ulysses Coronel	TELEPHONE: (951) 212-8917
LICENSING EVALUATOR SIGNATURE:	DATE: 04/29/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/29/2021

LIC9099 (FAS) - (06/04)

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Control Number 11-AS-20201221140355

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
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 04/29/2021

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 05/06/2021 Section Cited CCR 87468.2(a)(8)	1 2 3 4 5 6 7	87468.2(a)(8) Additional Personal Rights of Residents in Privately Operated Facilities. In addition to the rights listed in Section 87468.1, Personal Rights of Residents ...shall have ...rights: To be free from neglect...humiliation, intimidation, and verbal...abuse. This requirement was not met as evidenced by:	1 2 3 4 5 6 7	The Administrator will create a plan of correction indicating steps taken to ensure that Residents are free from verbal abuse. Plan of correction to be submitted to CCL by POC dute date.
	8 9 10 11 12 13 14	Based on interviewes and record reviewes the licensee failed to ensure that residents were free from verbal abuse, residents and staff interviews indicate that R1 was being verbally abused between February and December 2020, which poses a potential health and safety risk to clients in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (323) 981-3328
LICENSING EVALUATOR NAME: Ulysses Coronel	TELEPHONE: (951) 212-8917
LICENSING EVALUATOR SIGNATURE:	DATE: 04/29/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/29/2021

LIC9099 (FAS) - (06/04)

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