198602567-10-27-2023-11-AS-JCAN-CWZTU4-20231027150144

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 198602567
Report Date: 10/27/2023
Date Signed: 10/27/2023 03:01:50 PM

Document Has Been Signed on 10/27/2023 03:01 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT

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
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: 61	DATE:	10/27/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:55 AM
MET WITH:	ADMINISTRATOR KENIA PADILLA		TIME COMPLETED:	03:15 PM

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	On 10/27/2023 at 09:00 AM, Licensing Program Analyst (LPA) Jose Calderon conducted an unannounced annual inspection visit at Facility Regency Palms Long Beach. LPA Calderon was allowed entry into the facility by Administrator Kenia Padilla. The facility is licensed for 91 residents aged 59 and over. Currently, there are 61 residents residing in the facility. LPA Calderon explained to Administrator Kenia Padilla, the purpose of the 1-year Annual Inspection visit, and Administrator Kenia Padilla escorted LPA Calderon on a tour of the entire inside and outside facility grounds. As part of the inspection, LPA Calderon reviewed: Six resident service records, Six resident medication records. LPA Calderon interviewed six residents and six staff members for visit. LPA Calderon inspected the inside facility and outside grounds. The facilities’ last fire drill was conducted on 07/18/2023. The eight story commercial building has a memory care unit (floors 2,3,4,5,6) and assisted living community (floors 7,8) consisting of (56) resident bedrooms, (56) resident bathrooms, twelve common bathrooms, dining rooms, commercial kitchen, staff area, office area, commercial washer and dryer room/ storage area, Movie room, activity room, roof patio with umbrella, tables, and chairs. No weapons are stored on the premises. Commercial Kitchen was inspected and observed to be clean and operational. A 2-day supply perishable and 7-day supply of non-perishable foods are present in the facility kitchen. Seven day emergency water supply located in the kitchen and storage room.

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Jose Calderon	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 10/27/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/27/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)

Page: 1 of 3

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: 10/27/2023

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

During the visit, LPA Calderon observed the facility infection control practices. LPA Calderon observed screening protocols for visitors, staff, and residents, sanitizing stations (Located in common areas and restrooms). LPA Calderon observed staff and residents were wearing face coverings throughout the facility. LPA Calderon observed the facility has a 30-day supply of Personal Protective Equipment (PPE).

LPA Calderon advised the Administrator Kenia Padilla to continuously monitor the Centers for Disease Control (CDC) website and Community Care Licensing Provider Informational Notices (PIN) for any updates relating to COVID-19 guidance.
.
According to the California Code of Regulations (Title 22, Division 6, Chapter 8), LPA Calderon did not observe any deficiencies therefore no citations were issued at this time. An exit interview was conducted, and a copy of the Facility Evaluation Report was provided to Administrator Kenia Padilla.

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Jose Calderon	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 10/27/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/27/2023

LIC809 (FAS) - (06/04)

Page: 3 of 3

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: 10/27/2023

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

LPA Calderon observed that all facility rooms are clean and in good repair. A comfortable temperature of 73.0 degrees was maintained by central air and heating. LPA Calderon observed the following during inspection of resident rooms #402, #408, #608, #706, #804, #807. LPA Calderon noted that resident mattresses are in good condition, there is adequate lighting present, plenty of dresser/closet space is present, and all bed linens present. All bedrooms contain furniture, lighting fixtures and personal storage space as required, all beds have the required amount of linen and mattress covers, LPA Calderon observed fully stocked storage room with bedding, towels, and toiletries supplies. Bathroom fixtures are clean, in good repair, and working properly and contain the required nonskid mats and grab bars. LPA Calderon observed bathrooms were found to be within Title 22 regulation. Bathroom #1 hot water temperature properly measured at 113 degrees Fahrenheit, and bathroom #2 hot water temperature properly measured at 110 degrees Fahrenheit. Bathroom #3 hot water temperature properly measured at 113 degrees Fahrenheit. Bathroom #4 hot water temperature properly measured at 113 degrees Fahrenheit. Commercial Kitchen hot water temperature properly measured at 120 degrees Fahrenheit. The facility (10) Carbon Monoxide and (107) Smoke Detectors are hard wired and connected to each other. Smoke detectors were tested and are working properly. The facility has (39) Fire Extinguishers that were checked and found to be fully charged and accessible to staff and residents. All exit doors in the facility have alarm systems and security pads to unlock doors. All toxins and knifes are locked/secured and inaccessible to residents. Residents’ medications are centrally stored in the locked medication room and in a locked storage cabinet while on facility grounds. Facility has ten first aid kits which are fully stocked with manuals was checked and in order. All Exits/ Walkways around the facility were free of debris and hazards. Roof patio accessible to all residents. Six resident medications reports were checked, and they were all found to be administered according to doctor's orders. Six staff files were checked and have the required documents. The facility does NOT handle resident's money/cash resources. LPA Calderon noted the Administrator Kenia Padilla Certification # 6048819740 expiration date of 06/28/2024 was valid at time of visit. Commercial General Liability Policy #SHS0000780 policy period from 05/01/2023 to 05/01/2024 underwritten by Scottsdale Insurance Company, coverage 1,000,000/3,000,000 is valid at time of inspection. LPA Calderon spoke to Administrator Kenia Padilla who will email full copy of insurance contract which shows all coverages to LPA Calderon no later than 11/14/2023. All the required documents are posted in the facility in a clearly visible area to all staff, residents, and guests. LPA Calderon reviewed LIC500 and noted all staff associated to facility per LIS. LPA Calderon reviewed the resident roster, LPA Calderon confirmed residents’ interview are on resident roster.

SUPERVISOR'S NAME: Eva M Alvarez	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR NAME: Jose Calderon	TELEPHONE: (323) 981-1755
LICENSING EVALUATOR SIGNATURE:	DATE: 10/27/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/27/2023

LIC809 (FAS) - (06/04)

Page: 2 of 3