198602567-3-2-2024-11-AS-JHAD-D342E4-20240305161920

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198602567
Report Date: 03/02/2024
Date Signed: 03/02/2024 12:56:29 PM

Substantiated

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
07/06/2021 and conducted by Evaluator Ernand Dabuet

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20210706084504

FACILITY NAME:	REGENCY PALMS LONG BEACH		FACILITY NUMBER:	198602567
ADMINISTRATOR:	CARLA MARIANO		FACILITY TYPE:	740
ADDRESS:	117 E 8TH STREET		TELEPHONE:	(562) 432-9260
CITY:	LONG BEACH	STATE: CA	ZIP CODE:	90813
CAPACITY:	91	CENSUS: 62	DATE:	03/02/2024
		UNANNOUNCED	TIME BEGAN:	11:07 AM
MET WITH:	Fabiola Marciano		TIME COMPLETED:	12:24 PM

ALLEGATION(S):

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Neglect/lack of care and supervision resulted in the resident falling multiple times and sustaining an injury while in care.
Staff did not seek timely medical treatment for resident.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Ernand Dabuet made an unannounced visit to the facility and was greeted by Wellness Director (S4: Fabiola Mariano). LPA conducted a risk assessment prior to entering the facility. S4 informed LPA that the facility has no COVID cases nor do the residents or staff have symptoms. The purpose for today’s visit is to conduct a subsequent visit and deliver the findings pertaining to the above-mentioned allegations.

The investigation consisted of the following:
An initial 10-Day visit was conducted by LPA Susan Campos on 07/07/21 who met with Administrator Mariano. During the visit, LPA requested copies of files for R1-R5 Physician’s Reports (dated 07/09/21), Admission Agreement (dated 06/25/20), Emergency and Identification Information (dated 06/25/20), Appraisal/Needs & Services Plan (dated 07/12/21), Fall-Risk Plan (dated 06/25/20), Resident

(Evaluation Report continues LIC 9099-C)

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (424) 544-1027
LICENSING EVALUATOR NAME: Ernand Dabuet	TELEPHONE: (323) 629-5526
LICENSING EVALUATOR SIGNATURE:	DATE: 03/02/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/02/2024

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-20210706084504

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: 03/02/2024

NARRATIVE

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Assessment (dated 06/25/20), Hospice Care Plan (effective 07/08/21), Hospice Notes (dated 07/09/21), Medication Administration Records (June 2021 thru July 6, 2021), Administrator's Certificate, Facility Sketch, Facility Sign-in/Sign-out sheets (June 2021 thru July 6, 2021), Daily Routine Schedule (June 2021 thru July 6, 2021), House Rules, Facility Staff In-service Training (dated 04/30/21, 07/08/21, 07/09/21, 07/12/21, 07/13/21, 07/14/21, 07/15/21, 07/28/21), Incident Reports (dated 01/19/21, 01/29/21, 03/13/21, 05/31/21, 06/09/21, 06/19/21, 06/27/21), facility staff work schedules (June 25, 2021 thru June 30, 2021), facility staff and residents’ rosters.

This complaint investigation was referred to California Department of Social Services (CDSS), Investigation Bureau (IB) and assigned to Investigator Robert Kujawa. The investigation included interviews with medical services staff (Witness #1), family members (RP/POA), facility staff (A1, S1 – S5), and residents (R1 – R5) and a review of medical records (dated 07/01/21 – 07/08/21) from St. Mary Medical Center Long Beach.

INVESTIGATION REVEALED THE FOLLOWING:
Regarding Allegation #1: Resident #1 sustained multiple falls at the facility based on a review of facility incident reports (dated 01/19/21, 01/29/21, 03/13/21, 05/31/21, 06/09/21, 06/19/21, 06/27/21). Resident #1’s last known fall was on 06/27/21, the resident sustained an injury for which the resident did not receive medical treatment until four (4) days later 07/01/21. Facility staff notified the resident’s physician and family members about the fall; and Resident #1 showed no signs of injury or complaint of pain and discomfort at the time of the fall on 06/27/21. Resident #1 began complaining of pain in their right arm on 07/01/21; and facility staff notified the resident’s physician who examined Resident #1 who requested that the resident be transported to the hospital’s ER. Resident #1 was transported and admitted to St. Mary’s Hospital on 07/01/21. Upon discharge from the hospital on 07/08/21, Resident #1 returned to the facility with a sling on their right arm after undergoing treatment. Interviews conducted of medical services staff and a review of hospital medical records (dated 07/01/21 – 07/08/21) documented Resident #1 sustained a closed fracture of neck of right proximal humerus diagnosis during their last known fall on 06/27/21. Interviews conducted of facility staff corroborated that Resident #1 had sustained multiple falls and received the proper care from facility staff following each fall. Facility staff took steps according to the resident’s fall-risk plan to try and prevent further falls by vocalizing resident to ask for assistance.

(Evaluation Report continues LIC 9099-C)

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (424) 544-1027
LICENSING EVALUATOR NAME: Ernand Dabuet	TELEPHONE: (323) 629-5526
LICENSING EVALUATOR SIGNATURE:	DATE: 03/02/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/02/2024

LIC9099 (FAS) - (06/04)

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Control Number 11-AS-20210706084504

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: 03/02/2024

NARRATIVE

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Based on the evidence gathered and interviews conducted, and records reviewed, the preponderance of evidence standard has been met; therefore, the allegation of NEGLECT/LACK OF SUPERVISION: Neglect/lack of care and supervision resulted in the resident falling multiple times and sustaining an injury while in care is found to be SUBSTANTIATED.

According to the California Code of Regulations (Title 22, Division 6, Chapter 8), the following deficiency has been observed and citation(s) issued (ref. LIC 9099D). Civil penalty assessed.

Regarding Allegation #2: this investigation revealed that facility staff did not seek medical care to Resident #1 until four (4) days after the resident’s last known fall on 06/27/21 because the resident complained of pain to the right arm on 07/01/21. Resident #1 was transported to St. Mary’s Hospital Emergency Room (ER) for further evaluation and was admitted to the hospital with a diagnosis of right proximal humeral meris fracture. Resident #1 was evaluated by an orthopedic specialist recommending non-surgical intervention, as it would heal itself. Interviews conducted of facility staff corroborated that after each unforeseen fall, Resident #1 was evaluated for pain by facility staff - along with notifications made to the resident’s physician and family members based on documented incident reports (dated 01/19/21, 01/29/21, 03/13/21, 05/31/21, 06/09/21, 06/19/21, and 06/27/21). A review of the resident’s medical records documented that Resident #1 had a history of falls and was at a high-risk for falls. Resident #1’s physician recommended to facility staff: a plan of action - which facility staff updated and implemented on the resident’s appraisal/needs and services plan and fall-risk plan.

Based on the evidence gathered and interviews conducted, and records reviewed, the preponderance of evidence standard has been met; therefore, the allegation of NEGLECT/LACK OF SUPERVISION: Staff did not seek timely medical treatment for resident is found to be SUBSTANTIATED.

According to the California Code of Regulations (Title 22, Division 6, Chapter 8), the following deficiency has been observed and citation(s) issued (ref. LIC 9099D).

An exit interview has been conducted and a copy of the Complaint Report and Appeal Rights were provided to the Wellness Director (Fabiola Marciano).

ECP: At this time, an enhanced civil penalty determination is pending in reference to Health & Safety Code 1569.49(e)(1)(A) “Serious Bodily Injury” as defined in Section 243 of the Penal Code that states, a serious physical condition, including, but not limited to, the following: loss of consciousness; concussion; bone fracture; protracted loss or impairment of any bodily member or organ; a wound requiring extensive suturing; and serious disfigurement.”

SUPERVISOR'S NAME: Janae Hammond	TELEPHONE: (424) 544-1027
LICENSING EVALUATOR NAME: Ernand Dabuet	TELEPHONE: (323) 629-5526
LICENSING EVALUATOR SIGNATURE:	DATE: 03/02/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/02/2024

LIC9099 (FAS) - (06/04)

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Control Number 11-AS-20210706084504

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
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 03/02/2024

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 03/03/2024 Section Cited CCR 87465(a)(2)	1 2 3 4 5 6 7	Incidental Medical and Dental Care. (a) A plan for Incidental, medical and dental care shall be developed by each facility. The plan shall encourage routine medical and dental care and provide for assistance in obtaining such care... (2) The licensee shall provide assistance in meeting necessary medical and dental needs...	1 2 3 4 5 6 7	Licensee/Administrator shall read Title 22, Section “Incidental Medical and Dental Care" and send a written statement to CCLD no later than the POC date. The plan is due to the CCLD/El Segundo ASC Office by (03/03/24) fax at 424-544-1016 Attn: Elizabeth Ceniceros.
	8 9 10 11 12 13 14	This requirement is not met as evidenced by: Resident #1’s last known fall on 06/27/21; whereby, the resident sustained a closed fracture of neck of right proximal humerus injury for which the resident did not receive medical treatment until four (4) days later on 07/01/21. This violation posed an immediate health and safety to residents in care.	8 9 10 11 12 13 14	Immediate Civil Penalty $500.00
Type A 03/03/2024 Section Cited CCR 87705(c)(A)	1 2 3 4 5 6 7	Care of Persons with Dementia (c) Licensees who accept and retain residents with dementia shall be responsible for ensuring the following: (A) Dementia care including, but not limited to behavioral challenges...assisting with activities of daily living...skin care, communication...	1 2 3 4 5 6 7	Licensee/Administrator shall read Title 22, Section "Care of Persons with Dementia” and send a written statement to CCLD no later than the POC due date. The plan is due to the CCLD/El Segundo ASC Office by (03/03/24) fax at 424-544-1016 Attn: Elizabeth Ceniceros.
	8 9 10 11 12 13 14	This requirement is not met as evidenced by: Resident #1 had a history of falls based on the physician’s report. (R1's) PCP recommended to facility staff that a plan of action needs to be implemented for the resident due to being a high risk for falls. This violation posed an immediate health and safety to residents in care. NOTE: facility updated Fall-Risk Assessment (dated 07/08/21).	8 9 10 11 12 13 14

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: Janae Hammond	TELEPHONE: (424) 544-1027
LICENSING EVALUATOR NAME: Ernand Dabuet	TELEPHONE: (323) 629-5526
LICENSING EVALUATOR SIGNATURE:	DATE: 03/02/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/02/2024

LIC9099 (FAS) - (06/04)

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