198602069-5-23-2024-11-AS-UCOL-D5S2CL-20240530171656

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198602069
Report Date: 05/23/2024
Date Signed: 05/23/2024 03:08:16 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
03/04/2024 and conducted by Evaluator Socorro Leandro

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20240304121803

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: 132	DATE:	05/23/2024
		UNANNOUNCED	TIME BEGAN:	08:00 AM
MET WITH:	Administrator - Peggy Clark		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

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Staff did not assist resident in a timely manner.
Staff did not meet resident's needs.

INVESTIGATION FINDINGS:

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On 05/23/2024 Licensing Program Analyst (LPA) Leandro and LPA Cloyd conducted an unannounced, continuation complaint visit to the above-mentioned facility. LPA was met by Peggy Clark, Administrator and explained the purpose of the visit.
The investigation consisted of the following:
On 03/13/24 LPA Leon requested and reviewed facility documents and toured the facility. LPA Leon interviewed 10 out of 133 residents and 4 out of 72 staff.
On 05/09/2024 LPA Cloyd and LPA Leandro requested several facility records which included: Register of Residents, Shift Schedule, and Plan of Operation. LPAs interviewed 12 out of 132 residents and 6 out of 72 staff. LPA Leandro toured 2 residents’ rooms.
On 5/10/2024 LPA Cloyd and LPA Leandro interviewed 3 out of 66 staff.
On 5/23/2024 LPA Cloyd and LPA Leandro requested several facility records which included Resident’s 1 (R1s) records. LPAs interviewed 1 out of 132 residents and 1 out 72 staff.
A total of 22 resident interviews were conducted. A total of 14 staff interviews were conducted. Some interviewees were interviewed more than once.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Ulysses Coronel	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Socorro Leandro	TELEPHONE: 323-981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 05/23/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/23/2024

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-20240304121803

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: 05/23/2024

NARRATIVE

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The investigation revealed the following: Regarding the allegation “Staff did not assist resident in a timely manner” it is being alleged that the facility’s front desk did not answer R1’s call and that facility staff did not come to R1’s assistance in a timely manner. LPA Leandro interviewed R1 and R1 indicated that she did not call front desk when she fell in her bathroom, and she does not call facility because they do not help her. Interview with Caregiver that assisted R1 indicated that R1 informed Caregiver that R1 did not call anyone for assistance. Interviews conducted with residents and staff indicate that staff makes rounds every 30 minutes to 3 hours. Regarding the allegation, the allegation may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred, therefore the allegation is unsubstantiated.

The investigation revealed the following: Regarding the allegation “Staff did not meet resident's needs,” it is being alleged that the facility did not move R1 to a room without a shower tripping hazard. Record review indicates that facility staff moved R1 to four different rooms due to R1’s request. LPA did not observe a shower tripping hazard in R1’s room. Regarding the allegation, the allegation may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred, therefore the allegation is unsubstantiated.

No deficiencies were cited during today's visit.

An exit interview was conducted, and a copy of this report was left with the Administrator.

SUPERVISOR'S NAME: Ulysses Coronel	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Socorro Leandro	TELEPHONE: 323-981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 05/23/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/23/2024

LIC9099 (FAS) - (06/04)

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