198602069-11-8-2023-11-AS-UCOL-D2VPGU-20240228101854

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198602069
Report Date: 11/08/2023
Date Signed: 11/08/2023 04:03:49 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 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
11/02/2023 and conducted by Evaluator Mario Leon

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20231102103845

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: 130	DATE:	11/08/2023
		UNANNOUNCED	TIME BEGAN:	08:28 AM
MET WITH:	Peggy Clark, Assistant Administrator		TIME COMPLETED:	04:29 PM

ALLEGATION(S):

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Facility staff did not respond to residents' call buttons in a timely manner
Licensee does not ensure facility is adequately staffed at night to meet residents’ needs.

INVESTIGATION FINDINGS:

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On 11/08/23 Licensing Program Analyst (LPA) Mario Leon conducted an unanounced complaint visit at the above mentioned facility. LPA was met by Peggy Clark, Assistant Administrator (S1), and later by Veronica Gomez (S2) and the purpose of the visit was explained.

The investigation consisted of the following:
On 11/08/23, LPA took a tour of the facility, inside and out, which was conducted S1. LPA interviewed five (5) out of sixty-one (61) staff and nine (9) out of one-hundred thirty (130) Residents. LPA observed three (3) response times from call buttons throughout the facility. LPA obtained copies of the facility roster of residents, facility roster of staff and work schedules for staff on 11/08/23 through 11/09/23 which included AM/PM/Overnight (NOC) shifts.

Report continues, see LIC9099C

Unsubstantiated

Estimated Days of Completion: 90

SUPERVISOR'S NAME: Ulysses Coronel	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Mario Leon	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 11/08/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/08/2023

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-20231102103845

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: PALMCREST GRAND RESIDENCE	FACILITY NUMBER: 198602069
	VISIT DATE: 11/08/2023

NARRATIVE

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The investigation revealed the following:
Regarding the allegation: "Facility staff did not respond to residents' call buttons in a timely manner" It has been alleged that call notifications from the resident call buttons have gone unanswered or have taken an hour or longer for a response.
On 11/08/23 LPA interviewed 9 residents and asked about their use of the call button and the general response wait time. During the interviews, seven (7) out of nine (9) residents disagreed with the allegation. LPA observed two (2) out of 9 call buttons in disrepair. A technical violation has been cited, see LIC9102TV. LPA interviewed 5 staff and all 5 staff have provided an adequate response as how they receive and respond to residents' call buttons and what alternate actions occur during an emergency.
Based on the information collected, an inspection of the facility, observation, and interviews conducted, LPA found no evidence to support the allegation for this complaint.

Although the allegation 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.

Regarding the allegation: "Licensee does not ensure facility is adequately staffed at night to meet residents’ needs." It has been alleged that a resident had suffered from an unanswered call light, overnight.
On 11/08/23 LPA interviewed 9 residents and asked about their experience with overnight staff. Six (6) out of 9 residents have denied the allegation. LPA interviewed three (3) staff regarding the allegation and all 3 staff have denied the allegation. LPA reviewed records provided, including facility staff roster and NOC shift for 11/08/23 - 11/09/23. During interviews with S1, S2 and PM shift staff Anthony DeLeon (S4), all three (3) staff have provided an adequate response at how NOC shift is properly covered and how the facility would respond if there were to be a deficiency of California Code of Regulations 87415(a)(3).
Based on the information collected, an inspection of the facility, observation, record reviews, and interviews conducted, the Department found no evidence to support the allegation for this complaint.

Although the allegation 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 held with Assistant Administrator, Peggy Clark, and a copy of this report was provided.

SUPERVISOR'S NAME: Ulysses Coronel	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Mario Leon	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 11/08/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/08/2023

LIC9099 (FAS) - (06/04)

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