<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198602567
Report Date: 04/16/2021
Date Signed: 04/27/2021 01:36:19 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
MONTERY PARK, CA 91754
This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/24/2020 and conducted by Evaluator Susan Campos
PUBLIC
COMPLAINT CONTROL NUMBER: 11-AS-20201124105102
FACILITY NAME:REGENCY PALMS LONG BEACHFACILITY NUMBER:
198602567
ADMINISTRATOR:CARLA MARIANOFACILITY TYPE:
740
ADDRESS:117 E 8TH STREETTELEPHONE:
(562) 432-9260
CITY:LONG BEACHSTATE: CAZIP CODE:
90813
CAPACITY:91CENSUS: 58DATE:
04/16/2021
UNANNOUNCEDTIME BEGAN:
01:18 PM
MET WITH:Carla MarianoTIME COMPLETED:
05:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Residents are not changed in a timely manor due to insufficient staffing
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 4/16/2021, Licensing Program Analyst (LPA)/Susan Campos, initiated a subsequent complaint investigation visit to deliver findings for the allegation listed above. Due to the situation surrounding the Coronavirus Disease 2019 (COVID-19), and to implement mitigation measures, today’s subsequent complaint investigation was conducted telephonically with Carla Mariano. The investigation consisted of the following: LPA conducted telephone interviews with (9) staff members on 3/17/2021, and 4/14/21,and also conducted resident teleconference/ zoom interviews with (5) residents on 4/15/21. In addition, on 12/2/20, LPA conducted a telephone/video inspection, of the facilities’ physical plant and food supply for health and safety. Areas covered, in the teleconference, included: front door, common areas, office, dining room on each floor, kitchen, TV room/ living room on each floor, and also food supply. LPA also reviewed the following documents provided by Regency Palms Long Beach administrator Carla Mariano: LIC 500-staff roster, client roster, staff schedule, House Rules and Admission agreement. The LPA also requested copies of the staff roster, client roster, staff schedule, List Caregivers start date, work hours and assigned floor, Internal staff incident reports from June 2020 to present, Resident shower schedule, Documentation

Report continued on LIC 9099C
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Eva M AlvarezTELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Susan CamposTELEPHONE: (323) 629-7445
LICENSING EVALUATOR SIGNATURE:

DATE: 04/16/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/16/2021
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 9
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
MONTERY PARK, CA 91754
This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/24/2020 and conducted by Evaluator Susan Campos
PUBLIC
COMPLAINT CONTROL NUMBER: 11-AS-20201124105102

FACILITY NAME:REGENCY PALMS LONG BEACHFACILITY NUMBER:
198602567
ADMINISTRATOR:CARLA MARIANOFACILITY TYPE:
740
ADDRESS:117 E 8TH STREETTELEPHONE:
(562) 432-9260
CITY:LONG BEACHSTATE: CAZIP CODE:
90813
CAPACITY:91CENSUS: 58DATE:
04/16/2021
UNANNOUNCEDTIME BEGAN:
01:18 PM
MET WITH:Carla MarianoTIME COMPLETED:
05:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Residents are not receiving showers due to insufficient staffing
Staff are not properly trained
Staff are not meeting residents needs due to insufficient staffing
Staff are rough with residents
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 4/16/2021, Licensing Program Analyst (LPA)/Susan Campos, initiated a subsequent complaint investigation visit to deliver findings for the allegations listed above. Due to the situation surrounding the Coronavirus Disease 2019 (COVID-19), and to implement mitigation measures, today’s subsequent complaint investigation was conducted telephonically with Carla Mariano. The investigation consisted of the following: LPA conducted telephone interviews with (9) staff members on 3/17/2021, and 4/14/21,and also conducted resident teleconference/ zoom interviews with (5) residents on 4/15/21. In addition, on 12/2/20, LPA conducted a telephone/video inspection, of the facilities’ physical plant and food supply for health and safety. Areas covered, in the teleconference, included: front door, common areas, office, dining room on each floor, kitchen, TV room/ living room on each floor, and also food supply. LPA also reviewed the following documents provided by Regency Palms Long Beach administrator Carla Mariano: LIC 500-staff roster, client roster, staff schedule, House Rules and Admission agreement. The LPA also requested copies of the staff roster, client roster, staff schedule, List Caregivers start date, work hours and assigned floor, Internal staff incident reports from June 2020 to present, Resident shower schedule, Documentation of resident showers conducted from

Report continued on LIC 9099C
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Eva M AlvarezTELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Susan CamposTELEPHONE: (323) 629-7445
LICENSING EVALUATOR SIGNATURE:

DATE: 04/16/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/16/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 9
Control Number 11-AS-20201124105102
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
MONTERY PARK, CA 91754
FACILITY NAME: REGENCY PALMS LONG BEACH
FACILITY NUMBER: 198602567
VISIT DATE: 04/16/2021
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
November 1, 2020 - November 30, 2020. Schedule of caregiver's work shift resident continence assistance, and Caregiver end workshift report of resident hygiene services completed from November 1, 2020 to November 30, 2020. Caregivers training plan for new hire and continued training. Subsequent caregiver/ med tec training 2020. Caregiver hygiene task/duties during workshift.

Allegation: Residents are not receiving showers due to insufficient staffing

The investigation revealed, per LPA interviews, with (9) staff members, and (5) residents from the Regency Palms Long Beach facility, and also review of facility documents, that residents in the facility receive showers. S1 informed LPA that the facility, has a resident shower schedule, and the schedule lists, all caregiver, assigned resident shower weekly assignments. In addition, the caregiver signs off, on the shower schedule, when the resident shower has been completed, and also notations, if there was a reason when a shower, was not given, and the caregiver will try again to shower, the resident, at a later time, pending that the resident is cooperative. In addition, S1 also informed LPA that the Med Techs, supervise the caregivers, on the resident floors, and will make sure, that the caregiver shower schedule is being followed, and report to S2, if there are any concerns regarding resident showers. S1 states that the facility takes resident showers seriously, and checks to make sure that the resident's receive showers when scheduled. Family is also contacted if there are concerns, with a resident, not wanting a shower, and the care plan is noted, if there are behavior changes, so that the staff may accommodate, to assist the resident. As S1 states, if the resident refuses a shower on their scheduled day, staff try again later that day. S1 also stated that all workshifts at the facility are always covered, by a staff person picking up the shift, or by contacting back up staff. In addition, LPA interviewed (9) Regency Palms Long Beach staff persons and 9 of the 9 staff members interviewed, informed LPA, that they provide residents showers on their scheduled shower days. And also, 9 of 9 staff members, informed LPA, that the Med Tech, conducts rounds, during the work shift, and confirms that all residents, have been showered, and also reports to S2, if there are any residents that have refused a shower. Furthermore 9 of 9 staff members informed LPA, that there are enough caregivers and Med Techs, working on each shift and on each floor. Furthermore, LPA interviewed (5) residents, and 5 of 5 residents interviewed, informed LPA, that they receive showers, from caregivers, on their assigned day. Also 5 of 5 residents interviewed informed LPA, that they like the caregivers in the facility. LPA Campos, observed the resident shower schedule for March 2021, and observed that all residents have received their scheduled shower.
Based on information gathered, LPA did not find sufficient evidence to support allegation "Residents are not receiving showers due to insufficient staffing ”
Report continued on LIC 812C
SUPERVISOR'S NAME: Eva M AlvarezTELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Susan CamposTELEPHONE: (323) 629-7445
LICENSING EVALUATOR SIGNATURE:

DATE: 04/16/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/16/2021
LIC9099 (FAS) - (06/04)
Page: 3 of 9
Control Number 11-AS-20201124105102
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
MONTERY PARK, CA 91754
FACILITY NAME: REGENCY PALMS LONG BEACH
FACILITY NUMBER: 198602567
VISIT DATE: 04/16/2021
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Allegation: Staff are not properly trained

The investigation revealed, per LPA interviews, with (9) staff members, and (5) residents from the Regency Palms Long Beach facility, and also review of facility documents, that the facility train staff to conduct caregiving duties. S1 informed LPA that the facility trains caregivers once they are hired.

First, once a caregiver is hired, there are training sessions conducted, on computer modules, that go over the topics of resident care, and then the caregivers are taken to the resident floors, where they shadow, an experienced caregiver, so that they may observe the caregiver duties, and then they are also observed conducting caregiver services by the Med Tech and S2, to ensure that they are following resident care instructions. In addition, on-going in house training, conducted by an RN, is conducted on different caregiver service topics related to resident care. S1 also stated that all caregivers have been instructed and observed on how to conduct a two person assist. In addition, the Medtech on duty, supervises the caregivers, to insure, that caregivers, are following through with their job assignment, and if there is an issue with their job duties, this information is written up in the end shift report, and the Director of Wellness is informed, and immediate follow-up will occur. S1 also stated that does not know of any caregiver that is not trained in their position. This has not been reported to S1 or S2. The Med Techs supervise the floor, and observe that all caregivers are following up with their duties as required. In addition, LPA interviewed (9) Regency Palms Long Beach staff persons, and 9 of the 9 staff members interviewed informed LPA, that the facility trains the caregivers on all the tasks, that they need, in order to service the residents. Also there is always additional training sessions provided to caregivers. Also 9 of 9 staff person informed LPA, that they understand and know their caregiver duties. Furthermore 9 of 9 staff persons informed LPA that they have been trained on 2 person assist, and also know how to do an assist. Also 9 of 9 staff persons informed LPA that the med techs do rounds, and check the caregivers work, and also check on the residents. In addition, 5 of 5 residents interviewed, informed LPA, that the caregivers help them with their hygiene care. And 5 of 5 residents informed, LPA that did not have a problem with the caregivers understanding their needs requests. LPA reviewed facility staff training documents, for new hires, and observed that all required caregiver training topics, were covered in the modules, and also that shadow training sessions were conducted for the caregivers.

Based on information gathered, LPA did not find sufficient evidence to support allegation " Staff are not properly trained ”

Report continued on LIC 812C
SUPERVISOR'S NAME: Eva M AlvarezTELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Susan CamposTELEPHONE: (323) 629-7445
LICENSING EVALUATOR SIGNATURE:

DATE: 04/16/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/16/2021
LIC9099 (FAS) - (06/04)
Page: 4 of 9
Control Number 11-AS-20201124105102
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
MONTERY PARK, CA 91754
FACILITY NAME: REGENCY PALMS LONG BEACH
FACILITY NUMBER: 198602567
VISIT DATE: 04/16/2021
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Allegation: Staff are not meeting residents needs due to insufficient staffing

The investigation revealed, per LPA interviews, with (9) staff members, and (5) residents from the Regency Palms Long Beach facility, and also review of facility documents, that staff in the facility are meeting the residents needs. S1 informed LPA that all facility residents needs are cared for by the staff. S1 stated that the facility caregivers, provide hygiene, and other care needs to all residents that live in the facility. The caregivers are trained on how to complete their caregiver duties, so that all residents needs are cared for. In addition, S1 stated that during every work shift, there are caregivers, assigned to care, for the residents, and the med techs are the back up for every floor to assist the caregivers when needed. The caregivers are informed to contact the assigned med tech for assistance. S1 also stated that all workshifts are covered by a caregiver.
Also, if a caregiver calls out, and does not come in to work their shift, then a caregiver will pick up the open work shift or an on call staff person, will be contacted, for the assigned facility caregiver to work the shift.
S1 states that has not been informed by staff or residents that there are not sufficient number of staff persons on a caregiver work shift. And also the facility has sufficient staff to cover, all floors of the facility, and also enough staff, to assist all residents needs. In addition, S1 stated that Med Techs are also backup to assist caregivers when needed. Also, LPA interviewed 9 staff members, from the Regency Palms Long Beach facility, and 9 of 9 staff members informed LPA, that all residents needs are met, and also that there are sufficient number of staff to assist all residents. And also, 9 of 9 staff members, informed LPA, that if there is a staff person, that does not report to work, then another staff person will pick up the open work shift, and also if a staff person is not available to pick up the work shift then, a back up staff person will fill in.
Furthermore, LPA interviewed ( 5) residents, and 5 of 5 residents interviewed, informed LPA, that the staff at the facility are accessible to them when they need them, and that they have never had a problem finding a caregiver to assist them when needed. LPA Campos, observed the facility staff schedule for March 2021, and observed that all work shifts are covered by staff.

Based on information gathered, LPA did not find sufficient evidence to support allegation " Staff are not meeting residents needs due to insufficient staffing ”

Continued on LIC 9099C
SUPERVISOR'S NAME: Eva M AlvarezTELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Susan CamposTELEPHONE: (323) 629-7445
LICENSING EVALUATOR SIGNATURE:

DATE: 04/16/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/16/2021
LIC9099 (FAS) - (06/04)
Page: 5 of 9
Control Number 11-AS-20201124105102
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
MONTERY PARK, CA 91754
FACILITY NAME: REGENCY PALMS LONG BEACH
FACILITY NUMBER: 198602567
VISIT DATE: 04/16/2021
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Allegation: Staff are rough with residents

The investigation revealed, per LPA interviews, with (9) staff members, and (5) residents from the Regency Palms Long Beach facility, and also review of facility documents, that residents in the facility are not treated in a rough manner. S1 informed LPA that has not received a report, from staff or residents, that a resident has been treated rough by a staff person in the facility. S1 also informed LPA that the facility does not tolerate this behavior from a facility staff person, and would follow up with immediate disciplinary actions. Also, S1 informed LPA, that the facility staff are trained, when they are hired, on how to treat, and handle the residents, since the residents are delicate, and careful handling of the residents is important. In addition, S1 stated that the caregivers are supervised by Med Techs, and S2 and S3, during all work shifts, and they conduct floor rounds throughout a work shift, thereby providing constant supervision, and monitoring of caregiver duties and services. In addition, LPA interviewed (9) Regency Palms Long Beach staff persons, and 9 of the 9 staff members interviewed informed LPA, that never witnessed a staff person be rough with a resident, and also does not know of a resident that has been treated physically rough by a staff person.
Furthermore, LPA interviewed (5) residents, and 5 of 5 residents interviewed, informed LPA, that they have never been treated rough by a staff person at the facility, and also 5 of 5 residents informed LPA that they like the staff in the facility.

Based on information gathered, LPA did not find sufficient evidence to support allegation "Staff are rough with residents ”

Although the allegation may have happened or is 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 Carla Mariano, Administrator and a hard copy of a LIC 9099 was provided via email for signature.
SUPERVISOR'S NAME: Eva M AlvarezTELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Susan CamposTELEPHONE: (323) 629-7445
LICENSING EVALUATOR SIGNATURE:

DATE: 04/17/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/17/2021
LIC9099 (FAS) - (06/04)
Page: 6 of 9
Control Number 11-AS-20201124105102
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
MONTERY PARK, CA 91754
FACILITY NAME: REGENCY PALMS LONG BEACH
FACILITY NUMBER: 198602567
VISIT DATE: 04/16/2021
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
of resident showers conducted from November 1, 2020 - November 30, 2020. Schedule of caregiver's work shift resident continence assistance, and Caregiver end workshift report of resident hygiene services completed from November 1, 2020 to November 30, 2020. Caregivers training plan for new hire and continued training. Subsequent caregiver/ medtec training 2020. Caregiver hygiene task/duties during workshift.

Allegation: Residents are not changed in a timely manor

The investigation revealed, per LPA interviews, with (9) staff members, and (5) residents from the Regency Palms Long Beach facility, and also review of facility documents, that there have been incidents whereby residents at the facility were not changed in a timely manner during NOC shift. S2 informed LPA that there has been reports to S2, that a resident was not hygiene/ changed during the NOC shift. Once this was reported to S2, S2 investigated, and conducted retraining for the staff person; however, the staff person was dismissed, thereafter due to repeated incidents of not changing residents during NOC shift. S1 and S2 informed, the LPA, that the facility takes seriously any reported incidents of residents not changed when wet, regardless if it occurs during day or night workshifts. S2 further stated, that all caregivers are supervised and monitored, by the Med Tech, and reports are delivered to S2 for staff evaluation. In addition, LPA interviewed (9) Regency Palms Long Beach staff persons and 6 of the 9 staff members interviewed informed LPA, that their have been reports of residents, that have not been changed, during the NOC shift. And also, 9 of 9 staff members, informed LPA, that these incidents do not happen everyday, but do occur, on occasion, and that the caregivers, immediately report the incidents to the Medtech, so that S2 may be informed, and the NOC shift staff may be retrained. Furthermore, LPA interviewed (5) residents, and 5 of 5 residents interviewed, informed LPA, that they are assisted by the caregivers with their hygiene and toileting assistance. Also 5 of 5 residents interviewed informed LPA, that the caregivers are available when needed.

On 4/15/21, LPA was informed by 3 of 9 staff members that residents have been found, wet in the morning, after NOC shift.

Based on information gathered, LPA did find sufficient evidence to support allegation "Residents are not changed in a timely manor. ”

Continued on LIC 9099C.
SUPERVISOR'S NAME: Eva M AlvarezTELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Susan CamposTELEPHONE: (323) 629-7445
LICENSING EVALUATOR SIGNATURE:

DATE: 04/16/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/16/2021
LIC9099 (FAS) - (06/04)
Page: 7 of 9
Control Number 11-AS-20201124105102
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
MONTERY PARK, CA 91754
FACILITY NAME: REGENCY PALMS LONG BEACH
FACILITY NUMBER: 198602567
VISIT DATE: 04/16/2021
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Based on LPA observations and interviews which were conducted and record reviews, the preponderance of evidence standard has been met, therefore the above allegations is found to be substantiated. California Code of Regulations, Title 22, Division 6 and Chapter 8 are being cited on the attached LIC 9099D. A telephonic exit interview was conducted with Carla Mariano, Administrator and a hard copy of a LIC 9099 and LIC 9099D was provided via email for signature.
SUPERVISOR'S NAME: Eva M AlvarezTELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Susan CamposTELEPHONE: (323) 629-7445
LICENSING EVALUATOR SIGNATURE:

DATE: 04/16/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/16/2021
LIC9099 (FAS) - (06/04)
Page: 8 of 9
Control Number 11-AS-20201124105102
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
MONTERY PARK, CA 91754

FACILITY NAME: REGENCY PALMS LONG BEACH
FACILITY NUMBER: 198602567
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/16/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/16/2021
Section Cited
CCR
87464(f)(1)(c)
1
2
3
4
5
6
7
87464 Basic Services (f) Basic services shall at a minimum include:(1)Care and supervision as defined in Section 87101(c)(3) and Health and Safety Code section 1569.2(c).HANDBOOK BEGINS HERE Health and Safety Code section 1569.2(c) provides:(c) "Care and supervision" means the facility assumes responsibility for, or provides or promises to provide in the future, ongoing assistance with activities of daily living without which the resident’s physical health, mental health, safety, or welfare would be endangered. Assistance includes assistance with taking medications, money management, or personal care.

This requirement is not met as evidenced by:
1
2
3
4
5
6
7
Administrator will submit to LPA per fax a copy of a caregiver end of work shift plan that includes resident incogniet change before the end of NOC shift. POC due date is 5/3/21


LPA fax number is (323) 981-1781
POC Due Date is 5/3/21
8
9
10
11
12
13
14
Based on interviews, and record review, the licensee failed to ensure that residents were incontinent changed during the NOC shift, which posed a potential health risk to residents 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: Eva M AlvarezTELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Susan CamposTELEPHONE: (323) 629-7445
LICENSING EVALUATOR SIGNATURE:

DATE: 04/16/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/16/2021
LIC9099 (FAS) - (06/04)
Page: 9 of 9