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

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198602567
Report Date: 01/06/2025
Date Signed: 01/06/2025 04:32:36 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, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
This is an official report of an unannounced visit/investigation of a complaint received in our office on
12/09/2024 and conducted by Evaluator Socorro Leandro
COMPLAINT CONTROL NUMBER: 11-AS-20241209161139
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: 71DATE:
01/06/2025
UNANNOUNCEDTIME BEGAN:
09:40 AM
MET WITH:Executive Director, Fabiola MarcianoTIME COMPLETED:
05:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff do not secure residents medications.

INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 1/06/2025, the Department of Social Services (DSS) - Community Care Licensing Division (CCLD) staff conducted an unannounced subsequent complaint visit at this facility. CCLD staff was greeted by Executive Director, Fabiola Marciano.

The investigation consisted of the following:
On 12/17/2024, The department interviewed 1 witness and 2 staff.
On 12/18/2024, The department interviewed 1 witness.
On 12/30/2024, The department interviewed 1 witness.
On 1/2/2025 & 1/3/2025, The department reviewed facility records such as “Resident Incident Details Report”, Staff Time Cards, Resident Roster, Employee Roster, Resident Records, etc.
On 1/6/2025, The department interviewed 1 witness, 4 residents, and 4 staff.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Socorro Leandro
LICENSING EVALUATOR SIGNATURE:

DATE: 01/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/06/2025
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 7
Control Number 11-AS-20241209161139
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: 01/06/2025
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
The investigation revealed the following:
Regarding the allegation “Staff do not secure residents medications”, it is being alleged that staff do not secure medications (for example, medications refused by residents or not consumed by residents) where it is not accessible to residents in care. Interviews conducted revealed the following: 4 out of 4 resident interviews were inconclusive. 2 out 4 witnesses agreed with the allegation. 3 out of 5 staff who work on the Third Floor denied with the allegation. Observations revealed the following: On 12/17/2025, the department toured the Third Floor and did not observe medications. On 1/6/2025, the department toured the Third Floor and did not observe medications. Regarding the allegation, 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 allegation is unsubstantiated.

An exit interview was conducted, and a copy of this report was left with the Executive Director.
SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Socorro Leandro
LICENSING EVALUATOR SIGNATURE:

DATE: 01/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/06/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 7
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
This is an official report of an unannounced visit/investigation of a complaint received in our office on
12/09/2024 and conducted by Evaluator Socorro Leandro
COMPLAINT CONTROL NUMBER: 11-AS-20241209161139

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: 71DATE:
01/06/2025
UNANNOUNCEDTIME BEGAN:
09:40 AM
MET WITH:Executive Director, Fabiola MarcianoTIME COMPLETED:
05:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff do not ensure that residents incontinence needs are met.
Staff do not answer residents call buttons in a timely manner.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 1/06/2025, the Department of Social Services (DSS) - Community Care Licensing Division (CCLD) staff conducted an unannounced subsequent complaint visit at this facility. CCLD staff was greeted by Executive Director, Fabiola Marciano.

The investigation consisted of the following:
On 12/17/2024, The department interviewed 1 witness and 2 staff.
On 12/18/2024, The department interviewed 1 witness.
On 12/30/2024, The department interviewed 1 witness.
On 1/2/2025 & 1/3/2025, The department reviewed facility records such as “Resident Incident Details Report”, Staff Time Cards, Resident Roster, Employee Roster, Resident Records, etc.
On 1/6/2025, The department interviewed 1 witness, 4 residents, and 4 staff.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Socorro Leandro
LICENSING EVALUATOR SIGNATURE:

DATE: 01/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/06/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 7
Control Number 11-AS-20241209161139
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: 01/06/2025
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
The investigation revealed the following:

Regarding the allegation “Staff do not ensure that residents incontinence needs are met”, it is being alleged that there is a lack of incontinence care for residents in care, especially during nighttime; for example, not checking residents every two hours and/or leaving residents in soiled undergarments and clothing for extended periods of time.

Interviews conducted revealed the following: 4 out of 4 resident interviews were inconclusive. 2 out 3 caregivers who work on the Third Floor denied with the allegation. 4 out of 4 witnesses agreed with the allegation.

Records reviewed of “Resident Incident Details Report” of Pull Cords on the Third Floor from Rooms 301 to 308 dating from October 2024 to December 2024 revealed the following:
· There was 1 incident when the “Duration” took over 3 hours.
· There were 3 incidents when the “Duration” took over 2 hours.
· There were 9 incidents when the “Duration” took over 1 hour.
· There were 2 incidents when the “Duration” took over 50 minutes.
· There was 1 incident when the “Duration” took over 40 minutes.
· There were 5 incidents when the “Duration” took over 30 minutes.
· There were 11 incidents when the “Duration” took over 20 minutes.
13 out of 32 incidents occurred at nighttime from 6 PM to 12 AM.
3 out of the 6 residents of the “Resident Incident Details Report” require incontinence care according to their “Task Administration Record.”
* The “Duration” of alert indicates the time staff took to respond and “Reset Device” (reset pull cord device) in residents’ room. The “Duration” (alert) is only turned off when the device is reset. *
According to the Executive Director, the response time of staff should be 9 minutes or less.
SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Socorro Leandro
LICENSING EVALUATOR SIGNATURE:

DATE: 01/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/06/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 7
Control Number 11-AS-20241209161139
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: 01/06/2025
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
Records reviewed of “Task Administration Record” for the Third Floor of Residents who Require Incontinence Care for the Month of October 2024 & November 2024 revealed the following: 3 out 7 resident “Task Administration Record” for the Month of October 2024 and November 2024 under incontinence care are left blank; staff did not initial on date nor time. Therefore, there is no documented evidence that 3 out 7 residents were provided with incontinence care. 7 out 7 resident “Task Administration Record” for the Month of October 2024 and November 2024 under incontinence care are mostly left blank; staff did not initial on date nor time. Therefore, there is minimal documented evidence that incontinence care was provided to residents in care as required according to their "Task Administration Record."

Records reviewed of “Task Administration Record” for Resident 1’s Incontinence Care for the Month of October 2024 & November 2024 state the following: “#14 Continence – Assist w/ Toileting / Changing” “As Needed” missing initials from 10/1/2024 to 10/30/2024 and 11/1/2024 to 11/31/2024.
The document states the following:
“Instructions: Staff will need to assist resident every 1-2 hours to bathroom or as needed. Resident’s
Needs/Preferences: Requires for toileting and is taken to and from bathroom; needs assistance with
putting on and changing incontinence supplies, hygiene and/or changing linen…Service Provider
Responsibilities: Staff will assist resident every 2 hours each shift or as needed to soil of clothing,
hygiene.”
Therefore, there is no documented evidence that incontinence care was provided to Resident 1 from 10/1/2024 to 11/1/2024.

Regarding the allegation “Staff do not ensure that residents incontinence needs are met”, the preponderance of the evidence standard has been met therefore the allegation is substantiated.
SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Socorro Leandro
LICENSING EVALUATOR SIGNATURE:

DATE: 01/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/06/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 7
Control Number 11-AS-20241209161139
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: 01/06/2025
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
Regarding the allegation “Staff do not answer residents call buttons in a timely manner”, it is being alleged that staff members take over twenty minutes to answer residents call buttons (pull cords).

Records reviewed of “Resident Incident Details Report” of Pull Cords on the Third Floor from Rooms 301 to 308 dating from October 2024 to December 2024 revealed the following:
· There was 1 incident when the “Duration” took over 3 hours.
· There were 3 incidents when the “Duration” took over 2 hours.
· There were 9 incidents when the “Duration” took over 1 hour.
· There were 2 incidents when the “Duration” took over 50 minutes.
· There was 1 incident when the “Duration” took over 40 minutes.
· There were 5 incidents when the “Duration” took over 30 minutes.
· There were 11 incidents when the “Duration” took over 20 minutes.
There were 32 incidents where it took staff over 20 minutes to respond to a residents pull cord.
* The “Duration” of alert indicates the time staff took to respond and “Reset Device” (reset pull cord device) in residents’ room. The “Duration” (alert) is only turned off when the device is reset. *

Interviews conducted revealed the following: According to the Executive Director the response time of staff should be 9 minutes or less. Observations revealed the following: The department observed pull cords in resident bedrooms and resident bathrooms. Regarding the allegation “Staff do not answer residents call buttons in a timely manner”, the preponderance of the evidence standard has been met therefore the allegation is substantiated.
Deficiencies are being cited based on records reviewed and interviews conducted in accordance with the California Code of Regulations, Title 22. Deficiencies regarding incontinence care and staff response time. A civil penalty is being assessed due to it being a repeat violation, regarding incontinence care. An exit interview was conducted, and a copy of this report was left with the Executive Director along with their appeal rights.
SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Socorro Leandro
LICENSING EVALUATOR SIGNATURE:

DATE: 01/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/06/2025
LIC9099 (FAS) - (06/04)
Page: 6 of 7
Control Number 11-AS-20241209161139
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/06/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
01/28/2025
Section Cited
CCR
87625(b)(2)
1
2
3
4
5
6
7
87625 Managed Incontinence (b) In addition to...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 Executive Director has agreed to retrain staff on Incontinence Care and retrain on how to use and document on the facilities “Task Administration Record”.
The Executive Director will email Socorro.Leandro@dss.ca.gov
training records.
8
9
10
11
12
13
14
Based on records reviewed, the facility does have documented evidence that incontinence care was provided to 3 out 7 residents as required by their “Task Administration Record” for the months of 10/2024 and 11/2024; and there is minimal documented evidence that incontinence care was provided to 7 out 7 residents in care as required according to their "Task Administration Record”.
8
9
10
11
12
13
14
Type B
01/28/2025
Section Cited
CCR
87468.2(a)(4)
1
2
3
4
5
6
7
87468.2 Additional Personal Rights of Residents in Privately Operated Facilities (a) In addition to...the elderly shall have all of the following personal rights: (4) To care, supervision, and services that meet their individual needs and are delivered by staff that are sufficient in numbers, qualifications, and competency to meet their needs.

This requirement was not met as evidenced by:
1
2
3
4
5
6
7
The Executive Director has agreed to create a plan to ensure that residents pull cords are answered in a timely manner. The Executive Director will email plan to Socorro.Leandro@dss.ca.gov.
8
9
10
11
12
13
14
Based on records reviewed, staff did not answer residents pull cords in a timely manner. According to “Resident Incident Details Report” of Pull Cords on the Third Floor dating 10/2024 to 11/2024 there were 32 incidents where it took staff over 20 minutes to respond to a residents pull cord.
8
9
10
11
12
13
14
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: Ulysses Coronel
LICENSING EVALUATOR NAME: Socorro Leandro
LICENSING EVALUATOR SIGNATURE:

DATE: 01/06/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/06/2025
LIC9099 (FAS) - (06/04)
Page: 7 of 7