198602069-4-16-2021-28-AS-MVAO-C3CQTZ-20210525122754

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198602069
Report Date: 04/15/2021
Date Signed: 04/16/2021 04:15:45 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office,
, CA

This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/31/2019 and conducted by Evaluator Nicol Wesley

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20191031141422

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: 107	DATE:	04/15/2021
		UNANNOUNCED	TIME BEGAN:	05:39 PM
MET WITH:	Peggy Clark		TIME COMPLETED:	05:40 PM

ALLEGATION(S):

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Staff did not provide medical attention to residents.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Nicol Wesley 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 Assistant Program Manager Peggy Clark.

Investigation consisted of the following: LPA requested a copy of the staff roster, resident roster, Shower schedule for all residents residing in the facility including the memory care units on the first and second floor. LPA Wesley reviewed files for residents(#1-#7) and requested copies of specific documents for resident #1 and resident #2. LPA Wesley interviewed Assistant Program Manager Peggy Clark, Administrator Russell Amparano and random staff.

Investigation revealed the following regarding allegatoin: Staff did not provide medical attention to residents Continued on LIC 9099C.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Rebecca Orendain	TELEPHONE: (323) 981-3961
LICENSING EVALUATOR NAME: Nicol Wesley	TELEPHONE: (323) 981-3975
LICENSING EVALUATOR SIGNATURE:	DATE: 04/15/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/15/2021

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 28-AS-20191031141422

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office,
, CA

FACILITY NAME: PALMCREST GRAND RESIDENCE	FACILITY NUMBER: 198602069
	VISIT DATE: 04/15/2021

NARRATIVE

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LPA Wesley reviewed facility files for residents #1-#7 which also contained their medical information. LPA Wesley did not observe there to be any current cases or any indication that the residents are being treated for scabies. LPA Wesley did observed that the residents are currently being treated by a physician and observed there to be recent correspondence from a Physician/Nurse Practitioner, attending Dialysis appointments, and receiving assistance with elements of daily living. LPA observed the shower schedules that would allow staff who assist residents, identify or observe areas on the resident's body that would require medical attention. LPA also conducted interviews with staff and residents(#8-#15), and also observed medical correspondence in the resident files which confirmed that the currently facility physician is Dr. Adams not a Dr. Bucher whose name was referenced during the complaint investigation. The interviews with the Administrator, Assistant program manager and staff were consistent indicating the last scabies case they recall was in 2018, about 1.5 years ago.
Investigation revealed the following: Based on interviews conducted and observations made there was insufficient evidence to prove the allegation: "Staff failed to meet the resident's needs". Although the allegation(s) may have happened or are 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 Assistant Program Manager Peggy Clark, and a hard copy was provided via email to obtain signature.

SUPERVISOR'S NAME: Rebecca Orendain	TELEPHONE: (323) 981-3961
LICENSING EVALUATOR NAME: Nicol Wesley	TELEPHONE: (323) 981-3975
LICENSING EVALUATOR SIGNATURE:	DATE: 04/15/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/15/2021

LIC9099 (FAS) - (06/04)

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