<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198602567
Report Date: 12/16/2024
Date Signed: 12/16/2024 10:13:10 AM

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
10/31/2024 and conducted by Evaluator Felisa Shirley
COMPLAINT CONTROL NUMBER: 11-AS-20241031113210
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: 64DATE:
12/16/2024
UNANNOUNCEDTIME BEGAN:
09:18 AM
MET WITH:Fabiola Mariano, AdministratorTIME COMPLETED:
10:15 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff did not adequately assist resident with incontinence care needs in a timely manner.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 12/16/24, Licensing Program Analyst (LPA) Felisa Shirley conducted a subsequent unannounced 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, received and reviewed copies of the following records: Staff Roster and Resident Rosters. LPA Shirley requested the following records for R-1, incontinence log, Resident Incident Details Report, (pull cord log), Medication Administration Log (MAR) and Special Incident Reports (SIR’s), emergency information, physician’s report, Preplacement Appraisal Information, After visits forms, Appraisal Needs and Services and internal communications. LPA also interviewed staff 1 thru staff 7 and resident 1 thru resident 7.

The investigation revealed the following:
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Felisa Shirley
LICENSING EVALUATOR SIGNATURE:

DATE: 12/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/16/2024
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 4
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: 12/16/2024
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: Staff did not adequately assist resident with incontinence care needs in a timely manner.

On 11/6/24, LPA Shirley reviewed Appraisal Needs/Services and observed that it states R-1 is incontinent. During review of facility records, specifically incontinence log for R1, incontinence log is dated from 8/2/24 thru 11/4/24, with 4 months of changes entered on one sheet. The dates listed on the log are not consistent. A few dates are listed in order then the date skips to the next month without completing the prior month.

On 11/6/2024 LPA observed pull cords in the residents’ rooms. There are pull cords in every apartment unit located in the living room, bedroom and bathrooms. During the interview with S-2 on 11/6/24, LPA was told that residents on the Assisted Living floors also wear call pendants around their necks. LPA was also told by S-2 that the alert resets when units button is pushed. Upon review of facilities pull cord logs, LPA Shirley observed that dates ranged from 8/1/24 thru 11/6/24. Log lists the time call button is pushed by resident as well as the times caregivers respond and reset the call button. Per the log, there were 51 alerts with response times over 30 minutes, 8 alerts with response times over an hour and on 8/3/2024 the log lists that a pull cord was pushed at 4:46am and was lasted for a duration of three hours, forty-seven minutes and eighteen seconds, which was the longest time of delayed response from caregivers.

LPA Shirley interviewed staff-1 thru staff-7 (S-1 thru S-7). LPA asked if staff assist residents with incontinence needs in a timely manner. Of those interviewed, 6 out of 7 staff answered yes, and 1 answered no. LPA interviewed resident-1 thru resident-7 (R-1 thru R-7). LPA asked residents if staff assist them with incontinence needs in a

Con'd on 9099-C
SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Felisa Shirley
LICENSING EVALUATOR SIGNATURE:

DATE: 12/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/16/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 4
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: 12/16/2024
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
timely manner. Of those interviewed, 2 out of 7 answered yes, 1 answered no and 4 do not need incontinence assistance.

Based on interviews that were conducted, and records 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 LIC9099-D.
SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Felisa Shirley
LICENSING EVALUATOR SIGNATURE:

DATE: 12/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/16/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 4
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/16/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/30/2024
Section Cited
CCR
87625(b)(2)
1
2
3
4
5
6
7
87625 Managed Incontinence
(b) In addition to Section 87611, General Requirements for Allowable Health Conditions, the licensee shall be responsible for the following:
2) Ensuring that incontinent residents are checked during those periods of time when they are known to be incontinent, including during the night.

This requirement was not met as evidenced by:
1
2
3
4
5
6
7
The Adminstrator shall implement a system designed to answer pull cord alerts faster. Administrator will delegate the pull cord alerts over to the Med Techs which she feels will get a faster response in getting those alerts over to the caregivers to be of assistance to residents in care. Please send copies of Plan of Corrections to LPA Felisa Shirley by email at felisa.shirley@dss.ca.gov or by fax to (424)544-1016 by POC date of 12/30/24.

8
9
10
11
12
13
14
Based on interviews and records review, facility staff did not assist R-1 during the period of time when resident is known to be incontinent which poses a possible health and safety risk to persons in care.
8
9
10
11
12
13
14
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
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: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Felisa Shirley
LICENSING EVALUATOR SIGNATURE:

DATE: 12/16/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/16/2024
LIC9099 (FAS) - (06/04)
Page: 4 of 4