198602567-9-28-2026-11-AS-EMAZ-DYPV5L-20261009160806

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198602567
Report Date: 09/23/2026
Date Signed: 09/28/2026 12:51:51 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, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/15/2026 and conducted by Evaluator Ernand Dabuet

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20260915105149

FACILITY NAME:	REGENCY PALMS LONG BEACH		FACILITY NUMBER:	198602567
ADMINISTRATOR:	ROBERT JAKINI		FACILITY TYPE:	740
ADDRESS:	117 E 8TH STREET		TELEPHONE:	(562) 432-9260
CITY:	LONG BEACH	STATE: CA	ZIP CODE:	90813
CAPACITY:	91	CENSUS: 71	DATE:	09/23/2026
		UNANNOUNCED	TIME BEGAN:	02:06 PM
MET WITH:	Robert Jakini		TIME COMPLETED:	04:59 PM

ALLEGATION(S):

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Staff did not properly reappraise a resident while in care.

INVESTIGATION FINDINGS:

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On September 23, 2026, the California Department of Social Services/Community Care Licensing (CDSS/CCL) Licensing Program Analyst (LPA), Ernand Dabuet, conducted a subsequent unannounced complaint visit. Robert Jakini, Executive Director, greeted the LPA. (LPA) explained that the purpose of the visit is to investigate the allegations mentioned above.

The investigation included collecting documents and conducting a tour of the facility. A review of the Personnel Roster (dated 09/17/26 & 09/23/26), Resident Roster (dated 09/17/26 & 09/23/26), Resident #1 (R1's) Resident Lease Agreement, Physician's Report for Residential Care Facilities LIC 602A, Service Plan, Resident Assessment, Resident Notes & Incidents,30-Day Notice to Terminate and other pertinent records associated with this complaint. Interviews were conducted with Resident #1-Resident #7 (R1-R7), Staff #1 -Staff #2 (S1-S2). and Witness #1 (W1).

(Evaluation Report continues LIC 9099-C)

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ernand Dabuet
LICENSING EVALUATOR SIGNATURE:	DATE: 09/23/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/23/2026

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-20260915105149

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

FACILITY NAME: REGENCY PALMS LONG BEACH	FACILITY NUMBER: 198602567
	VISIT DATE: 09/23/2026

NARRATIVE

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INVESTIGATION REVEALED THE FOLLOWING:

Allegation: Staff did not properly reappraise a resident while in care.

It is alleged that Resident #1 (R1) was not properly reappraised. Reports indicate that (R1's) reappraisal was conducted without (R1's)c presence and that no arrangements were made for their involvement. Additionally, it appears only the Executive Director completed the reappraisal document, violating Title 22 87463(i) and 87467. No further details were provided.

On September 17, 2026, and September 23, 2026, between 02:06 PM and 03:07 PM, the Department interviewed staff members identified as Staff #1 and Staff #2 (S1-S2). Two (2) out of the two (2) staff members could not corroborate this claim. (S1-S2) reported that they monitor residents regularly and update reappraisal information when they observe changes in a resident’s condition. (S1) stated that, in (R1’s) situation, (R1) has had no change in condition since (R1's) last appraisal on June 23, 2026. (R1) has not been hospitalized; there has been no physical change in condition, no change in cognitive or mental status, no change in medical needs, and no change in ability to perform ADLs independently. (S1) stated that on September 10, 2026, (S1) was asked to conduct a reappraisal by (R1’s) resident advocate, even though (R1’s) condition had not changed. (S1) stated that they would comply, and the reappraisal took place in person with (R1) present and (R1’s) advocate in attendance. The reappraisal was sent to (R1) by email on September 11, 2026, and (R1) signed it on September 18, 2026. (S1-S2) denied in violation of Title 22 regulations 87463(i) and 87467.

On September 18, 2026, and September 23, 2026, between 3:30 PM and 5:00 PM, the Department interviewed residents identified as Resident #1 through Resident #7 (R1-R7). Six (6) of seven (7) residents could not corroborate this claim. (R2-R7) reported they have been presented along with their representatives during their pre-appraisal or reappraisal assessment process. (R1) confirmed to be present during an in-person care meeting with (R1’s) advocate on September 10, 2026, with the Executive Director. (R1) verified that (R1’s) care needs were discussed and evaluated during the care meeting and were being evaluated in response to (R1’s) dietary issues.

On September 22, 2026, between 11:53 AM and 12:00 PM, the Department interviewed a witness member identified as Witness #1 (W1). (W1) confirmed being present at (R1’s) Care meeting on September 10, 2026.

(Evaluation Report continues LIC 9099-C)

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ernand Dabuet
LICENSING EVALUATOR SIGNATURE:	DATE: 09/23/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/23/2026

LIC9099 (FAS) - (06/04)

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Control Number 11-AS-20260915105149

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

FACILITY NAME: REGENCY PALMS LONG BEACH	FACILITY NUMBER: 198602567
	VISIT DATE: 09/23/2026

NARRATIVE

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(W1) verified that they requested the facility to conduct a reappraisal for (R1), and care needs were discussed during the meeting, but (W1) did not feel it was a proper assessment. (W1) did not disclose why (W1) felt it was not conducted properly, but verified that (R1) was present during the assessment.

The Department reviewed (R1’s) Physicians Report LIC602A (dated 05/09/24) Service Plan (dated 07/24/25), Resident Assessment (dated 09/11/26 & 06/23/26), DHCS Individual Service Plan (dated 06/26/24), and Facility Notes & Incidents (dated 07/02/25 & 07/22/26) Further review of several physician medical notes (dated 08/21/26, 01/27/26, 08/04/26 & 10/03/25).

Based on file review, interviews, and observations, there was insufficient evidence to support the allegation.

Based on the information collected from the facility inspection, observations, interviews, and records analysis, the Department found no evidence to support the above 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 cited.

An exit interview was conducted with Robert Jakini, and copies of the reports were provided.

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Ernand Dabuet
LICENSING EVALUATOR SIGNATURE:	DATE: 09/23/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/23/2026

LIC9099 (FAS) - (06/04)

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