198602567-3-12-2024-11-AS-EMAZ-D3SVJ8-20240328162819

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198602567
Report Date: 03/11/2024
Date Signed: 03/12/2024 07:58:29 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/02/2023 and conducted by Evaluator Wendy Gibbs

COMPLAINT CONTROL NUMBER: 11-AS-20230802134530

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: 58	DATE:	03/11/2024
		UNANNOUNCED	TIME BEGAN:	11:19 AM
MET WITH:	Kenia Padilla-Sanchez		TIME COMPLETED:	03:55 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Facility failed to obtain resident’s representative admission agreement signature at the time of and as a condition of admission.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

On 03/11/24, Licensing Program Analyst (LPA), Wendy Gibbs, conducted an unannounced visit to the facility listed above to deliver findings for the allegation listed above. LPA met with Executive Director, Kenia Padilla-Sanchez, and explained the purpose of today’s visit.

During a previous visit conducted on 08/09/23, LPA toured the facility, interviewed Staff (S1-S4), interviewed residents (R2-R6) received, and reviewed the following documents Resident’s Admission Packet, Resident Power of Attorney paperwork, Physicians Report, Resident Service Plan, ID/Emergency Information Sheet, and Preplacement Appraisal information.

The investigation revealed the following:

Continued on LIC9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Wendy Gibbs	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 03/11/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/11/2024

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 2

Control Number 11-AS-20230802134530

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: REGENCY PALMS LONG BEACH	FACILITY NUMBER: 198602567
	VISIT DATE: 03/11/2024

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: Facility failed to obtain resident’s representative admission agreement signature at the time of and as a condition of admission.
It has been alleged that the appointed fiduciary Power of Attorney signed the admitting documents as the Responsible Person.
During the course of the investigation, LPA reviewed the Resident’s (R1) admission agreement, and in that agreement states the services that will be provided by the facility and the cost and additional fees for those services provided. Additionally on page 22 of the Admission Agreement titled Responsible Person Agreement states, “the responsible person signing is responsible payor and guarantor will be responsible for payment of all fees due under or arising from this Agreement.” The admission agreement was signed by the Resident’s (R1) fiduciary Power of Attorney, who was responsible for handling the Resident (R1) finances and ensuring all fees and services were paid for. During an interview with the Executive Director S1, stated when there is an Advanced Healthcare Directive and/or fiduciary, we review the documents pertaining to who has the authority to make medical and financial decisions. We ask to be provided with documents regarding who has the authority to made medical decisions and financial decisions.
During the course of the investigation, LPA was unable to find any evidence supporting the allegation. Although the allegation may have happened or is valid, there is no preponderance of evidence to prove the above allegation did or did not occur, therefore the allegation is unsubstantiated.

No deficiencies were observed or cited during today’s visit.

LPA conducted an exit interview with Executive Director, Kenia Padilla, and a copy of this report was emailed due to technical issues with LPA's printer.

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Wendy Gibbs	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 03/11/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/11/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 2