198602567-6-26-2020-28-AS-MVAO-BRCP3J-20200709105738

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198602567
Report Date: 06/25/2020
Date Signed: 06/26/2020 03:38:29 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
12/13/2019 and conducted by Evaluator Renee Arterberry

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20191213155556

FACILITY NAME:	REGENCY PALMS LONG BEACH		FACILITY NUMBER:	198602567
ADMINISTRATOR:	CHRISTINE TOMLINSON		FACILITY TYPE:	740
ADDRESS:	117 E 8TH STREET		TELEPHONE:	(562) 432-9260
CITY:	LONG BEACH	STATE: CA	ZIP CODE:	90813
CAPACITY:	91	CENSUS: 57	DATE:	06/25/2020
		UNANNOUNCED	TIME BEGAN:	11:00 AM
MET WITH:	Carla Mariano, administrator		TIME COMPLETED:	05:00 PM

ALLEGATION(S):

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Resident sustained pressure injury while in care
Residents diaper not changed in a timely manner resulting in a rash
Facility staff not responding to residents call button

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Ren’ee Arterberry initiated a Complaint Follow-Up Visit to investigate the allegations noted 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 Carla Mariano the facility administrator of Regency Palms Long Beach. The investigation consisted of the following: on 12/19/2019 at 1:54 PM the LPA interviewed the facility administrator and at 3:18 PM the Wellness Director was interviewed and she shall be referred to as, S1. At 1:56 PM the LPA requested, received and reviewed the facility file for a former resident who shall be referred to as, R1. The following documents: Meridian Senior Living Memory Care Admission Agreement, Physician's Report for Residential Care Facilities for the Elderly (LIC 602) dated 10/12/19, Meridian Senior Living Memory Care Unusual Incident/Injury Report (SIR) dated 11/7/2019, Resident's Notes, Progress Notes, 30-Day Notification of Agreement Termination dated 11/08/2019, Regency Palms Long Beach/Meridian Senior Living Resident Financial Statement, Meridian Senior Living Resident Assessment form (8 pages), Fall Risk Assessment, Elopement Risk Assessment, Self-Management of Medications Evaluation, Appraisal/Needs and Services Plan (dated 10/22/2019).

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Wei Siew Ho	TELEPHONE: (323) 981-3969
LICENSING EVALUATOR NAME: Renee Arterberry	TELEPHONE: (323) 981-3342
LICENSING EVALUATOR SIGNATURE:	DATE: 06/25/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/25/2020

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 1 of 4

Control Number 28-AS-20191213155556

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: REGENCY PALMS LONG BEACH	FACILITY NUMBER: 198602567
	VISIT DATE: 06/25/2020

NARRATIVE

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College Medical Center Medical Records. On 06/25/2020 at 10:30 AM the LPA interviewed the Wellness Director and she shall be referred to as S1, the LPA also interviewed five (5) caregivers and they shall be referred to as, S2, S3, S4, S5 and S6. The LPA attempted to interview another caregiver who shall be referred to as, S7 but she did not answer the phone. The LPA interviewed a total of four (4) residents and they shall be referred to as R2, R3, R4, and R5. A former resident who shall be referred to as, R1 was not interviewed due to his major neurocognitive disorder.
The investigation reveal the following: A former resident who shall be referred to as R1 sustained a pressure injury while in care: R1 was admitted to Regency Palms Long Beach on October 19, 2019. No history of skin condition or breakdown noted on Physician's Report for Residential Care Facilities for the Elderly dated 10/13/2019 during time of admission. On 11/05/2019 it is noted by the Home Health Care Nurse that R1 was diagnosed with, "a very superficial open skin on his right bottom area". The administrator state, to the best of her knowledge, R1 did not have a bed sore. The Home Health Care Nurse, would have notified them if a bed sore was observed. However, the nurse reported that R1 had a superficial sore on his right buttock. It was a rash and there was no broken skin. S1 who is the facility Wellness Director state that she too acknowledge that S1 had what she describe as a rash on his buttock and deny that it was a pressure sore. S6 who was assigned to provide care to R1 state that she seen a rash, "a cluster of bumps" on R1's buttock. S6 also state that although she was a relatively new hire and was in training as a caregiver for R1. To the best of her knowledge S6 did not have, she deny observing pressure injuries on the body of R1. The administrator and S1 also state that the caregivers are instructed to notify management or one of the facility nurses of any skin abnormalities. All caregivers confirm that it is company policy to notify Management/Wellness Director or Administrator of skin abnormalities or a skin change is observed. On 11/07/2019 at approximately 3:00 PM R1 was observed with shallowed breathing. 911 was called and R1 was transported by ambulance to College Memorial Hospital Emergency Room. It is noted on the College Medical Hospital Emergency Room Report that R1's skin was, "warm and dry, no rash or skin wounds. Accompanied by swelling in both legs/edema bilaterally ".
R1's diaper was not changed in a timely manner resulting in a rash: the administrator and S1
state all incontinent resident's diapers are changed every two hours. Caregivers also conduct rounds to check the incontinent residents to ensure they are clean and dry. All caregivers state that they are trained and they conduct rounds every hour to check the incontinent residents to ensure they are clean and dry. The caregivers also state they change the incontinent diapers every two hours. The caregivers deny that the residents are being left in soiled diapers.

SUPERVISOR'S NAME: Wei Siew Ho	TELEPHONE: (323) 981-3969
LICENSING EVALUATOR NAME: Renee Arterberry	TELEPHONE: (323) 981-3342
LICENSING EVALUATOR SIGNATURE:	DATE: 06/25/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/25/2020

LIC9099 (FAS) - (06/04)

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Control Number 28-AS-20191213155556

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: REGENCY PALMS LONG BEACH	FACILITY NUMBER: 198602567
	VISIT DATE: 06/25/2020

NARRATIVE

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The three incontinent residents state that the caregivers check on them many times throughout the day and during the night. The residents deny that they are being left in soiled diapers. The residents further state that they do not activate the Emergency Call Button to request the caregivers to change their diaper. It shall be noted that the other residents interviewed are not incontinent.

Facility staff not responding to residents call button: the administrator and S1 state that when a resident activate the Emergency Call System, the medication room is notified. The medication technician will notify the caregivers via walkie talkie. The caregiver who is closest to the area will respond by stating they are responding to the call. The administrator and S1 also state that the respond time is approximately 8 to 10 minutes. The administrator and S1 deny that staff fail to respond when the Emergency Call Button is activated. The caregivers state that each resident have an Emergency Response Button that hang round their neck. Each caregiver have a walkie talkie. When the caregiver is notified (via walkie talkie) that a resident require emergency assistance, the caregiver who is closest to the resident will respond. The caregivers take the stairs because the stairs are faster than waiting for the elevator. The caregivers further state that the response time is approximately 5 to 10 minutes. The caregivers do not fail to respond when the Emergency Response System is activated.

All of the residents state that they have used the Emergency Call System at various times of the day, night and early mornings. When they activated the system, caregivers arrived to the area (bedroom or common area) within 10 mns. The residents deny that the staff failed to respond to the Emergency Call System. The caregivers arrived to the area very quickly.

Facility file for R1's records and hospital records were obtained and reviewed. The LPA interviewed the facility administrator, four caregivers, the facility Wellness Director, financial director and a total of four (4) residents were interviewed. Three residents were incontinent and all have experienced emergencies and activated the Emergency Call System. Based on the evidence; interviews conducted, file documents and medical records obtained the finding is unsubstantiated. As noted on the Progress Notes entry date 11/05/2019 by Home Health Care Nurse, R1 was diagnosed with a "superficial open skin on his right buttock". As noted on the College Hospital Skin Abnormality Report dated 11/11/2019 R1 was diagnosed with a Stage 2 Pressure Injury. As noted in Title 22 Regulations, "the licensee shall be permitted to accept or retain a resident who has a healing wound under the following circumstances:

SUPERVISOR'S NAME: Wei Siew Ho	TELEPHONE: (323) 981-3969
LICENSING EVALUATOR NAME: Renee Arterberry	TELEPHONE: (323) 981-3342
LICENSING EVALUATOR SIGNATURE:	DATE: 06/26/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/26/2020

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 28-AS-20191213155556

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: REGENCY PALMS LONG BEACH	FACILITY NUMBER: 198602567
	VISIT DATE: 06/25/2020

NARRATIVE

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When care is performed by or under the supervision of an appropriately skilled professional. Residents with a stage one or two pressure injury must have the condition diagnosed by a physician or an appropriately skilled professional. The resident shall receive care for the pressure injury from a physician or an appropriately skilled professional". All of the requirements noted above were in place when R1 was a resident of Regency Palms Long Beach. There was no evidence to support that R1 had a pressure injury while he was a resident of Regency Palms.

Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations; resident sustained pressure injury while in care, residents diaper not changed in a timely manner resulting in a rash and facility staff not responding to residents call button, did or did not occur; therefore, the complaint investigation of the allegations is unsubstantiated.

No Deficiencies cited under California Code of Regulations Title 22

An exit Interview was conducted via telephone with the administrator and a hardcopy was provided via email for signature. Signatures on hardcopies.

SUPERVISOR'S NAME: Wei Siew Ho	TELEPHONE: (323) 981-3969
LICENSING EVALUATOR NAME: Renee Arterberry	TELEPHONE: (323) 981-3342
LICENSING EVALUATOR SIGNATURE:	DATE: 06/25/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/25/2020

LIC9099 (FAS) - (06/04)

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