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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198602567
Report Date: 11/18/2024
Date Signed: 11/18/2024 01:57:59 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
11/12/2024 and conducted by Evaluator Zina Brown
PUBLIC
COMPLAINT CONTROL NUMBER: 11-AS-20241112103247
FACILITY NAME:REGENCY PALMS LONG BEACHFACILITY NUMBER:
198602567
ADMINISTRATOR:KENIA SANCHEZ PADILLAFACILITY TYPE:
740
ADDRESS:117 E 8TH STREETTELEPHONE:
(562) 432-9260
CITY:LONG BEACHSTATE: CAZIP CODE:
90813
CAPACITY:91CENSUS: 68DATE:
11/18/2024
UNANNOUNCEDTIME BEGAN:
09:26 AM
MET WITH:Fabiola Mariano, AdministratorTIME COMPLETED:
02:15 PM
ALLEGATION(S):
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Staff did not administer medication to residents as prescribed.
INVESTIGATION FINDINGS:
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On 11/18/2024 at 9:17am, Licensing Program Analyst (LPA) Zina Brown and Licensing Program Manager (LPM) Janae Hammond initiated a unannounced complaint investigation for the allegation listed above. During today’s visit, LPA and LPM met with Fabiola Mariano Administrator.

The investigation consisted of the following:
On 11/18/2024, LPA and LPM interviewed Administrator (A1), Staff # 1-3 (S1 – S3) and Residents #1-6 (R1 – R6) and 8 medication administration record review. LPA also obtained copies of staff roster (dated on 10/29/2024), resident roster (on 11/18/2024), and 8 medication administration records (for the month of November) and staff training in medication administration (dated 08/06/2024).

Report continues on LIC 9099-C.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Zina Brown
LICENSING EVALUATOR SIGNATURE:

DATE: 11/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/18/2024
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 3
Control Number 11-AS-20241112103247
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: 11/18/2024
NARRATIVE
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The investigation revealed the following:
Allegation: Staff did not administer medication to residents as prescribed.

On 11/18/2024 between the hours of 11:44am – 12:07 pm, LPA interviewed Administrator (A1) and Staff # 1 – Staff #4 regarding the allegation. 2 out of the 4 staff interviews, confirmed the allegation and 2 of the 4 staff interviewed denied the allegation.

On 11/18/2024 between the hours 11:05am – 11:26 am interviewed residents #1 - #6, 3 out of the 6 residents confirmed the allegation and 3 out of 6 residents denied being aware of the allegations.

On 11/18/2024 at 1:15pm, LPA conducted 8 medication administration record review whihc revealed the following: for 1 out 8 residents medication review, revealed the facility does not have the residents prescribed medication for trazadone, senna and setraline. 7 out 8 resident medication review revealed, the medication administration record is not signed that resident was administrated the medication for various dates.

Substantiated: Based on LPAs observations and interviews which were conducted and the records that were reviewed, the preponderance of evidence standard has been met, therefore the above allegation is found to be substantiated. California Code of Regulations, Title 22, Division 6 and Chapter 8 are being cited on the attached LIC 9099D.

Civil penalty is assessed in the account of $250 for repeat violation with 12 month period.

Exit interview conducted with Fabiola Mariano (Administrator) and copy of the report and appeal rights were provided.
SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Zina Brown
LICENSING EVALUATOR SIGNATURE:

DATE: 11/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/18/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 11-AS-20241112103247
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: 11/18/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
11/19/2024
Section Cited
CCR
87465(a)(4)
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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:
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Administrator will develop a plan to ensure that medication administration records are checked frequently to avoid discrepancies. Administrator will submit plan to LPA by POC due date. CIVIL PENATLY ASSESSED.
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Based on observation, interviews and records review the administrator failed to ensure medication for 8 out 8 resident medications reviewed was not adminstrated accurately. This poses an immediate health and safety risk to residents in care.
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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: Janae Hammond
LICENSING EVALUATOR NAME: Zina Brown
LICENSING EVALUATOR SIGNATURE:

DATE: 11/18/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/18/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 3