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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198602567
Report Date: 05/01/2024
Date Signed: 05/01/2024 01:53:05 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
03/25/2024 and conducted by Evaluator Jose Calderon
COMPLAINT CONTROL NUMBER: 11-AS-20240325160311
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: 82DATE:
05/01/2024
UNANNOUNCEDTIME BEGAN:
12:53 PM
MET WITH:DIRECTOR
FABIOLA MARCIANO		TIME COMPLETED:
02:00 PM
ALLEGATION(S):
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9
Staff did not seek timely medical care for resident.
INVESTIGATION FINDINGS:
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13
This report supersedes the report dated 04/17/2024, the purpose of this amendment is to provide clarification regarding staff interviews and to provide correct investigation findings for allegation "Staff did not seek timely medical care for resident." from Unsubstantiated to Substantiated. On 04/17/2024 Licensing Program Analyst (LPA) Jose Calderon conducted an unannounced visit to the facility Regency Palms Long Beach and was greeted by Director Fabiola Marciano (S3). LPA Jose Calderon spoke to S3 prior to entering the facility to conduct a risk assessment. LPA Jose Calderon explained the purpose of this visit is to deliver the findings pertaining to the above-mentioned allegations.
The investigation consisted of the following: LPA Jose Calderon interviewed Administrator (A1), resident (R1-R10), staff (S1-S3), witness (W1). This interview was conducted on 04/02/2024, 04/03/2024 and 04/17/2024. LPA Calderon obtained and reviewed copies of the following: Physician report (date 01/09/2024), Incident report (date 03/22/2024), resident notes (date 03/21/2024 to 04/01/2024), Shower logs (date 03/22/2024), body check analysis form (date 02/21/2024, 02/23/2024 and 02/27/2024) for R1 and Inservice training for staff (date 03/23/2024). The investigation revealed the following:
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Ulysses CoronelTELEPHONE: (323) 400-7397
LICENSING EVALUATOR NAME: Jose CalderonTELEPHONE: (323) 213-1153
LICENSING EVALUATOR SIGNATURE:

DATE: 05/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/01/2024
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 6
Control Number 11-AS-20240325160311
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: 05/01/2024
NARRATIVE
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Regarding Allegation: Staff did not seek timely medical care for resident.

This complaint alleged that staff did not seek timely medical care for R1. A1 states that A1 understands that R1 did fall and somehow injured R1 right arm. A1 states that all staff are trained to give aid to a resident that is injured. S1 states that R1 grabbed the bathroom sink and somehow cut R1 right arm. S1 states that S1 was working alone and had 12 other residents to take care of. S1 states that S1 forgot to call the Med teck and care for the wound. S1 states that 1 hour passed until the med teck took care of the injury to R1 right arm. S2 states that S2 received a call from S3 regarding R1 injury. S2 states that S2 went to R1 room and asked staff what happened to R1 arm. S2 states that S2 was told that R1 lost balance and injured R1 arm on the bathroom sink. S2 states that S2 generated an incident report and called R1 family and Wellbe Home Health Care. S3 states that S3 was made aware of the situation and called S2 to take care of R1 wound. S3 states that S1 forgot to call the med teck and additional training would be provided to staff. R1 does not remember the incident that happened on 03/22/2024. 9 out of 10 residents states that staff take care of resident medical needs in a timely manner. Reviewed the in-service training (date 03/23/2024), training on what to do if a resident refuses to take a shower and what to do if the resident is injured. Reviewed incident report (date 03/22/2024), incident happened around 11:30am on 03/22/2024. R1 lost balance and injured R1 right arm. LPA Calderon interviewed W1, who states that W1 witnessed R1 had an injury to R1 right arm. W1 states that W1 asked S1 to call S2 to treat R1 arm. W1 states that S2 did arrive and treated R1 injury.

Based on LPA Calderon observations and interviews which were conducted and the records that were reviewed, the preponderance of evidence standard has been met, therefore the above allegations “Staff did not seek timely medical care for resident” is found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division 6 are cited on the attached LIC 9099D.

An exit interview was conducted, and plans of corrections were developed. A copy of the Complaint Report and the appeals rights was provided to the DIRECTOR
FABIOLA MARCIANO (S3).

SUPERVISOR'S NAME: Ulysses CoronelTELEPHONE: (323) 400-7397
LICENSING EVALUATOR NAME: Jose CalderonTELEPHONE: (323) 213-1153
LICENSING EVALUATOR SIGNATURE:

DATE: 05/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/01/2024
LIC9099 (FAS) - (06/04)
Page: 6 of 6
Control Number 11-AS-20240325160311
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: 05/01/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/10/2024
Section Cited
CCR
87466
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87466 Observation of the Resident. The licensee shall ensure that residents are regularly observed for changes in physical, mental, emotional and social functioning and that appropriate assistance is provided....any. This requirement is not met as evidenced by:
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Administrator will provide additional training regarding title 22 regulations 87466 "Observation of the resident". Plan of correction will be sent to LPA Calderon via email.
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Based on interviews, and record review, the licensee did not ensure that appropriate assistance was provided to R1. On 10/02/2023 S1 did not seek timely medical care to R1. This poses a 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.
SUPERVISOR'S NAME: Ulysses CoronelTELEPHONE: (323) 400-7397
LICENSING EVALUATOR NAME: Jose CalderonTELEPHONE: (323) 213-1153
LICENSING EVALUATOR SIGNATURE:

DATE: 05/01/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/01/2024
LIC9099 (FAS) - (06/04)
Page: 5 of 6
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
03/25/2024 and conducted by Evaluator Jose Calderon
COMPLAINT CONTROL NUMBER: 11-AS-20240325160311

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: 82DATE:
05/01/2024
UNANNOUNCEDTIME BEGAN:
12:53 PM
MET WITH:ADMINISTRATOR KENIA PADILLATIME COMPLETED:
02:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff forced resident to shower.
Staff handled resident in a rough manner.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
This report supersedes the report dated 04/17/2024, the purpose of this amendment is to provide clarification regarding staff interviews andto provide correct investigation findings for allegation "staff forced resident to shower.""staff handled residnt in a rough manner" remain the same Unsubstantiated On 04/17/2024 Licensing Program Analyst (LPA) Jose Calderon conducted an unannounced visit to the facility Regency Palms Long Beach and was greeted by Director Fabiola Marciano (S3). LPA Jose Calderon spoke to S3 prior to entering the facility to conduct a risk assessment. LPA Jose Calderon explained the purpose of this visit is to deliver the findings pertaining to the above-mentioned allegations.
The investigation consisted of the following: LPA Jose Calderon interviewed Administrator (A1), resident (R1-R10), staff (S1-S3), witness (W1). This interview was conducted on 04/02/2024, 04/03/2024 and 04/17/2024. LPA Calderon obtained and reviewed copies of the following: Physician report (date 01/09/2024), Incident report (date 03/22/2024), resident notes (date 03/21/2024 to 04/01/2024), Shower logs (date 03/22/2024), body check analysis form (date 02/21/2024, 02/23/2024 and 02/27/2024) for R1 and Inservice training for staff (date 03/23/2024). The investigation revealed the following:
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Ulysses CoronelTELEPHONE: (323) 400-7397
LICENSING EVALUATOR NAME: Jose CalderonTELEPHONE: (323) 213-1153
LICENSING EVALUATOR SIGNATURE:

DATE: 05/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/01/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 6
Control Number 11-AS-20240325160311
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: 05/01/2024
NARRATIVE
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Regarding Allegation #1: Staff forced resident to shower.

This complaint alleged staff forced resident to take a shower. A1 states no staff forces a resident to take a shower. A1 states that if a resident refuses to take a shower staff try 3 or 4 times to give the resident a shower. A1 states that R1 has health issues and refuses to take a shower. A1 states that all staff are given training on how to care for a resident that refuses to take a shower. S1 states that R1 was scheduled for a shower. S1 states that R1 grabbed the bathroom sink and appears to be falling. S1 states that S1 put S1 arms around R1 waist and picked R1 up. S1 states that S1 put R1 in the shower and R1 calmed down. S1 states that R1 has health issues. S3 states that all S3 staff are trained not to force a resident to take a shower. S3 states that R1 would be given 3 chances to change R1 mind and if R1 refuses to take a shower an incident report is generated and R1 family would be called. S3 states that S1 did not force R1 into the shower. R1 does not remember the incident that happened on 03/22/2024. 9 out of 10 residents state that staff have never forced residents to take a shower if residents did not want to take a shower. Reviewed physician report (date 01/09/2024), R1 needs help undressing and taking a shower. Reviewed the shower logs (date 03/22/2024) R1 was schedule for 3 showers per week. Reviewed the in-service training (date 03/23/2024), no staff is to force a resident to take a shower. LPA Calderon interviewed W1, who states that R1 advised W1 that staff had forced R1 to take a shower.

Regarding Allegation #2: Staff handled resident in a rough manner.

This complaint alleged staff handled R1 in a rough manner. A1 states that no staff handles any resident roughly. A1 states that most resident have health issues and A1 staff are trained to handle resident with care. S1 states that S1 has worked with R1 for a long time and R1 was undressed for a shower. S1 states that R1 grabbed at the bathroom sink and appeared to be falling. S1 states that S1 grabbed at R1 waist to prevent R1 from falling to the floor. S1 states that S1 prevented R1 from falling. S1 states that S1 would not handle any resident in a rough manner. S3 states that all staff are given training on how to care for residents with health conditions. S3 states that no staff would handle a resident in a rough manner. R1 could not remember the incident that happened on 03/22/2024 but did show LPA Calderon R1 right arm which appeared to be not injured. 9 out of 10 residents state that staff treat them with respect and have never grabbed resident in a rough manner. LPA Calderon observed staff and residents doing daily exercises and LPA Calderon did not see staff treat any resident in a rough manner.

SUPERVISOR'S NAME: Ulysses CoronelTELEPHONE: (323) 400-7397
LICENSING EVALUATOR NAME: Jose CalderonTELEPHONE: (323) 213-1153
LICENSING EVALUATOR SIGNATURE:

DATE: 05/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/01/2024
LIC9099 (FAS) - (06/04)
Page: 4 of 6
Control Number 11-AS-20240325160311
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: 05/01/2024
NARRATIVE
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3
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12
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Based on interviews and supporting documentation, the allegation may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred; therefore, the allegations of “staff forced resident to shower”, “staff handled resident in a rough manner” is found to be UNSUBSTANTIATED.

An exit interview was conducted, and a copy of the Complaint Report was provided to the DIRECTOR
FABIOLA MARCIANO (S3).

SUPERVISOR'S NAME: Ulysses CoronelTELEPHONE: (323) 400-7397
LICENSING EVALUATOR NAME: Jose CalderonTELEPHONE: (323) 213-1153
LICENSING EVALUATOR SIGNATURE:

DATE: 05/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/01/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 6