198602567-11-6-2024-11-AS-RORN-DDTMLM-20250212084232

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198602567
Report Date: 11/06/2024
Date Signed: 11/06/2024 04:27:45 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
10/31/2024 and conducted by Evaluator Felisa Shirley

COMPLAINT CONTROL NUMBER: 11-AS-20241031113210

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:	11/06/2024
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Fabiola Mariano, Administrator		TIME COMPLETED:	04:30 PM

ALLEGATION(S):

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Staff neglect resulted in resident falling.

INVESTIGATION FINDINGS:

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On 11/6/24, Licensing Program Analyst (LPA) Felisa Shirley conducted an unannounced subsequent visit to this facility. LPA was met by Robin Walker, Resident Care Coordinator, and explained the purpose of the visit is to investigate and deliver findings for the allegations mentioned above. LPA was granted access to the facility.

The investigation consisted of the following:
On 11/6/24 LPA Felisa Shirley requested and received copies of the following records: Staff Roster, Resident Rosters, incontinence logs, emergency push logs, MAR and SIR’s. LPA Felisa Shirley reviewed resident’s logs and received copies of identification and emergency information, physician’s report, Preplacement Appraisal Information, After visits forms, Appraisal Needs and Services and internal communications.

The investigation revealed the following:

Con'd on 809-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Felisa Shirley
LICENSING EVALUATOR SIGNATURE:	DATE: 11/06/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/06/2024

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-20241031113210

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: 11/06/2024

NARRATIVE

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Allegation: Staff neglect resulted in resident falling.

On 11/6/24, LPA Felisa Shirley reviewed resident’s facility file. Upon review of C-1’s Physicians Report, C-1 is a fall risk. LPA reviewed a Special Incident Report in which on 10/31/24, C-1 began slipping from soap during a shower. C-1 began sliding so caregiver guided resident to a sitting position on the floor of the shower. Med Tech and Wellness director were notified. C-1’s family was also notified that resident was assessed, there was no fall, and he was not in any danger. Family stated that they did not see any need to send him to the ER. On 11/6/24, LPA toured facility and went to client’s room and observed that there was no plastic chuck placed on top of the sheets. LPA did observe a large bath towel folded and placed on the bed sheets, on the side of the bed that C-1 sleeps on to avoid sliding and falls. LPA did not observe any special incident reports that reported any falls.

LPA Shirley interviewed staff-1 thru staff-7 (S-1 thru S-7). LPA asked, does staff neglect result in resident falls? Of those interviewed, 7 out of 7 answered no. LPA interviewed Client-1 thru Client-7 (C-1 thru C-7). LPA asked, have you had any falls due to staff neglect?” Of those interviewed, 7 out of 7 answered no. Based on information gathered, LPA did not find sufficient evidence to support the allegation “Staff neglect resulted in resident falling,” therefore the allegation is unsubstantiated.

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Felisa Shirley
LICENSING EVALUATOR SIGNATURE:	DATE: 11/06/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/06/2024

LIC9099 (FAS) - (06/04)

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