198602567-10-2-2024-11-AS-RORN-DAZRRM-20241114121522

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198602567
Report Date: 10/02/2024
Date Signed: 10/02/2024 06:34:49 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
09/25/2024 and conducted by Evaluator Troy Watson

COMPLAINT CONTROL NUMBER: 11-AS-20240925105558

FACILITY NAME:	REGENCY PALMS LONG BEACH		FACILITY NUMBER:	198602567
ADMINISTRATOR:	KENIA SANCHEZ PADILLA		FACILITY TYPE:	740
ADDRESS:	117 E 8TH STREET		TELEPHONE:	(562) 432-9260
CITY:	LONG BEACH	STATE: CA	ZIP CODE:	90813
CAPACITY:	91	CENSUS: 67	DATE:	10/02/2024
		ANNOUNCED	TIME BEGAN:	10:22 AM
MET WITH:			TIME COMPLETED:	06:30 PM

ALLEGATION(S):

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Staff did not give resident medication
Staff are not documenting medications properly

INVESTIGATION FINDINGS:

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On 10/02/24, Licensing Program Analyst (LPA) Troy Watson and Licensing Program Manager (LPM) Stephanie Cifuentes, conducted an unannounced complaint visit at this facility and were greeted by the Executive Director Fabiola Mariano and Wellness Director Robin Walker. LPA explained the purpose of the visit is to gather information regarding the above allegations. And was allowed entrance into the facility.

The investigation consisted of the following: On 10/02/2024 LPA interviewed staff #1-#6 (S1-S6) and interviewed residents #1-#5 (R1-R5). LPA Watson requested, received, and reviewed Physician's Reports, Medication Administration Records (MARs) and Admission Agreements for R1-R5.

Continued on 9099-C

Substantiated

Estimated Days of Completion:

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Troy Watson
LICENSING EVALUATOR SIGNATURE:	DATE: 10/02/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/02/2024

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 11-AS-20240925105558

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: 10/02/2024

NARRATIVE

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The allegations revealed the following:

Allegation: Staff did not give resident medication
On 10/02/24 the Department audited the facilities Medication Administration Records (MAR) dated September 2024. Documents were reviewed for 5 residents, and 5 out of 5 MAR’s showed residents did not receive medication several days in September 2024. All MAR’s reviewed show blanks spaces and no notation that medication was refused, or resident was out of the community for several different dates and times.

On 10/02/24 LPA Watson interviewed staff #1-#6 (S1-S6), of those interviewed 2 out of 6 stated they believed residents had not received medications. On 10/02/24 LPA Watson interviewed residents #1-#5 (R1-R5). Of those interviewed, 5 out of 6 stated they believed they had not received medications.

Based on evidence gathered, interviews conducted, records reviewed, the preponderance of evidence standard has been met; therefore, the allegation of " Staff did not give resident medication " is found to be found to be SUBSTANTIATED.

Allegation: Staff are not documenting medications properly
On 10/02/24 the Department audited the facilities Medication Administration Records (MAR) dated September 2024. Documents were reviewed for 5 residents, and 5 out of 5 MAR’s showed blank spaces throughout the record. Per the charting codes given on the eMar, there is a code for each action, so there should be no blanks spaces for daily medications.

Continued on 9099-C

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Troy Watson
LICENSING EVALUATOR SIGNATURE:	DATE: 10/02/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/02/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 4

Control Number 11-AS-20240925105558

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: 10/02/2024

NARRATIVE

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On 10/02/24 LPA Watson interviewed staff #1-#6 (S1-S6) and of those interviewed 1 out of 6 stated the MAR had not been documented properly. LPA Watson asked the additional question of what blank spaces meant on the MAR, and of those interviewed, 4 out of 6 stated blank spaces meant the medications were not properly documented. On 10/02/24 LPA Watson interviewed residents #1-#5 (R1-R5). Of those interviewed, 3 out of 6 stated they believed there medications had not been properly documented.

Based on evidence gathered, interviews conducted, records reviewed, the preponderance of evidence standard has been met; therefore, the allegation of " Staff are not documenting medications properly" is found to be found to be SUBSTANTIATED.

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

An exit interview has been conducted and a copy of the Complaint Report and Appeal Rights was provided to the Executive Director Fabiola Mariano.

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Troy Watson
LICENSING EVALUATOR SIGNATURE:	DATE: 10/02/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/02/2024

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 11-AS-20240925105558

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: 10/02/2024

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 10/30/2024 Section Cited CCR 87465(a)(4)	1 2 3 4 5 6 7	87465 Incidental Medical and Dental Care ...The licensee shall assist residents with self-administered medications as needed. This requirment has not been met as evidenced by:	1 2 3 4 5 6 7	Administrator will conduct staff medication training through Relias and with local pharmacy. Facility will provide copies of transcripts to CCL via email/fax by POC due dates.
	8 9 10 11 12 13 14	On 10/2/2024 LPA Troy Watson observed on eMAR that medications had been missed for residents 1-5 for month of September 2024. This is a potential health and safety risk to clients in care.	8 9 10 11 12 13 14
Type B 10/30/2024 Section Cited CCR 87506(a)	1 2 3 4 5 6 7	Resident Records The licensee shall ensure that a separate, complete, and current record is maintained for each resident in the facility or in a central administrative location readily available to facility staff and to licensing agency staff. This requirment has not been met as evidenced by:	1 2 3 4 5 6 7	Wellness director will check eMAR at end of every shift to verify medication is properly documents. Facility will provide POC via email/fax by due date.
	8 9 10 11 12 13 14	On 10/2/2024 LPA Troy Watson observed that eMAR that sections had been left blank, when they should have a charting code. This is a potential health and safety risk to clients in care.	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.

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Troy Watson
LICENSING EVALUATOR SIGNATURE:	DATE: 10/02/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/02/2024

LIC9099 (FAS) - (06/04)

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