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

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198602567
Report Date: 03/12/2025
Date Signed: 03/12/2025 05:59:27 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, 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
02/24/2025 and conducted by Evaluator Wendy Gibbs
COMPLAINT CONTROL NUMBER: 11-AS-20250224150148
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: 74DATE:
03/12/2025
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Fabiola MarcianoTIME COMPLETED:
05:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff did not provide medication assistance to resident in care
Staff falsified resident's records
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 03/12/2025 at 9:05AM, Licensing Program Analyst (LPA), Wendy Gibbs, conducted an unannounced subsequent complaint visit to the facility listed above. LPA met with Executive Director, Fabiola Marciano, and the purpose of today’s visit was explained. LPA was granted entry into the facility.

Investigation consisted of the following:
During today's visit, LPA attempted to interviewed Resident R1 again, interviewed Residents R9 and R10, additional interviews with Staff S2, S7, and S8, interviewed Staff S9, and conducted additional review of medications and eMAR for residents.
During the initial visit on 03/04/2025, LPA toured the facility, interviewed Staff S1-S8, interviewed Residents R1-R8, and received documents pertinent to the investigation. The following documents were received and reviewed: Staff Roster, Resident Roster, Resident Physician’s Report, Resident Physician’s Order, Resident Medication Administration Record (MAR), RPLB Work Order Management, and Med Tech In-Service log.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Wendy Gibbs
LICENSING EVALUATOR SIGNATURE:

DATE: 03/12/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/12/2025
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-20250224150148
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: 03/12/2025
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
Allegation: Staff did not provide medication assistance to resident in care.
The details of the complaint alleges staff did not provide resident with their medications.
During LPA’s visit on 03/12/2025, LPA reviewed medications with Staff S7 and S8. LPA reviewed the medications for seven (7) residents, LPA observed seven (7) out of seven (7) residents’ medications were not consistent with documentation of medication administration. LPA observed three (3) out of seven (7) residents have medications that are not listed on the eMAR. Additionally, LPA observed three (3) out of seven (7) residents have medication that is listed on the eMAR but there are no medications.

During file review, LPA received and reviewed the eMAR for seven (7) residents and observed medications were not properly documented when taken (initialed by Med Tech), refused, or out of the community.

During interviews, on 03/04/2025 and 03/12/2025, with Staff S1-S9, were asked if residents are provided their medication as prescribed, ten (10) out of ten (10) stated they provide residents with their medications as prescribed.

During interviews, on 03/04/2025 and 03/12/2025, with Residents R1-R10, were asked if staff provide them their medications as prescribed, one (1) out of ten (10) stated they do not receive their medications as prescribed.

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Wendy Gibbs
LICENSING EVALUATOR SIGNATURE:

DATE: 03/12/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/12/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 7
Control Number 11-AS-20250224150148
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: 03/12/2025
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
Allegation: Staff falsified resident’s records.
The details of the complaint alleges staff indicated on the Medication Administration Record that a medication was administered to a resident when it was not.

During LPA’s visit on 03/12/2025, LPA reviewed the eMAR and medications for seven (7) residents, LPA observed three (3) out of seven (7) residents had medications that were signed off as provided but were still in the bubble pack.

During file review, LPA received and reviewed the eMAR for seven (7) residents and observed medications were not properly documented as taken (initialed by Med Tech), refused, out of the community, or other.

During interviews, on 03/04/2025 and 03/12/2025, with Staff S1-S10, were asked if staff had signed off that a medication was provided by a Med Tech and it was not provided, four (4) out of nine (9) stated there was an occasion when a Med Tech signed that a medication had been provided by them and it was not.

During the course of the investigation, LPA was able to find evidence to support the allegations. Based on LPAs observations and interviews which were conducted and record review(s), the preponderance of evidence standard has been met, therefore the above allegation(s) is found to be SUBSTANTIATED. California code of Regulation, (Tittle 22, Division 6 & Chapter number 8), are being cited on the attached LIC 9099D

A civil penalty was assessed for a repeat violation within the last 12 months.

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Wendy Gibbs
LICENSING EVALUATOR SIGNATURE:

DATE: 03/12/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/12/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 7
Control Number 11-AS-20250224150148
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: 03/12/2025
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
LPA, Executive Director, and Wellness Director discussed a referral to the Technical Support Program regarding medication management.

An exit interview was conducted with Executive Director, Fabiola Marciano, and a copy of this report and the Appeal Rights were provided.
SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Wendy Gibbs
LICENSING EVALUATOR SIGNATURE:

DATE: 03/12/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/12/2025
LIC9099 (FAS) - (06/04)
Page: 4 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
02/24/2025 and conducted by Evaluator Wendy Gibbs
COMPLAINT CONTROL NUMBER: 11-AS-20250224150148

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: 74DATE:
03/12/2025
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Fabiola MarcianoTIME COMPLETED:
05:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff did not safeguard resident's personal belongings
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 03/12/2025 at 9:05AM, Licensing Program Analyst (LPA), Wendy Gibbs, conducted an unannounced subsequent complaint visit to the facility listed above. LPA met with Executive Director, Fabiola Marciano, and the purpose of today’s visit was explained. LPA was granted entry into the facility.

Investigation consisted of the following:
During today's visit, LPA attempted to interviewed Resident R1 again, interviewed Residents R9 and R10, additional interviews with Staff S2, S7, and S8, interviewed Staff S9, and conducted additional review of medications and eMAR for residents.
During the initial visit on 03/04/2025, LPA toured the facility, interviewed Staff S1-S8, interviewed Residents R1-R8, and received documents pertinent to the investigation. The following documents were received and reviewed: Staff Roster, Resident Roster, Resident Physician’s Report, Resident Physician’s Order, Resident Medication Administration Record (MAR), RPLB Work Order Management, and Med Tech In-Service log.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Wendy Gibbs
LICENSING EVALUATOR SIGNATURE:

DATE: 03/12/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/12/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 5 of 7
Control Number 11-AS-20250224150148
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: 03/12/2025
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
Allegation: Staff did not safeguard resident’s personal belongings.
The details of the complaint alleges a residents responsible party has seen their Resident’s clothing is missing and being worn by other residents.
During LPA’s visit on 03/04/2025 and 03/12/2025, LPA observed a resident on the third floor leave personal belongings in the common room and staff took the item to the resident.
During file review, LPA received and reviewed Resident’s R1-R8’s Client/Resident Personal Property and Valuables (LIC621), LPA observed eight (8) out of eight (8) indicated and signed on the form they decline to have their items inventoried. Additionally, LPA received and reviewed the Theft and Loss Policy provided to the Residents that states it is encouraged for residents to fill out the Resident Personal Property and Valuables form.
During interviews, on 03/04/2025 and 03/12/2025, with Staff S1-S9, four (4) out of nine (9) stated sometimes residents clothing get mixed up or a resident will take another residents belongings.
During interviews, on 03/04/2025 and 03/12/2025, with Residents R1-R10, were asked if they have had any personal belongings that have gone missing, four (4) out of ten (10) stated they have had some of their personal belongings go missing.

During the course of the investigation, LPA was unable to find evidence to support the allegation. Although the allegation may have happened or is valid, there is no preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated.


An exit interview was conducted and a copy of this report was provided.
SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Wendy Gibbs
LICENSING EVALUATOR SIGNATURE:

DATE: 03/12/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/12/2025
LIC9099 (FAS) - (06/04)
Page: 6 of 7
Control Number 11-AS-20250224150148
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: 03/12/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
03/13/2025
Section Cited
CCR
87465(a)(4)
1
2
3
4
5
6
7
87465 Incidental Medical and Dental Care (a) A plan for incidental medical and dental care shall be developed by each facility. The plan shall encourage routine medical and dental care and provide of assistance in obtaining such care, by compliance with the following: (4) The Licensee shall assist residents with
1
2
3
4
5
6
7
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.
8
9
10
11
12
13
14
 self-administered medications as needed.
Based on observation and record review Staff failed to ensure medication for 7 out 7 resident medications reviewed was not adminstrated accurately. This poses an immediate health and safety risk to residents in care.
8
9
10
11
12
13
14
Type A
03/13/2025
Section Cited
CCR
87506(a)
1
2
3
4
5
6
7
87506 Resident Records (a)The licensee shall ensure that a separate, complete, and current record is maintained for each resident in the facility or in a central administrative location readily available to facility staff and to licensing agency staff.
1
2
3
4
5
6
7
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.
8
9
10
11
12
13
14
Based on observations, interviews, and record review Staff failed to ensure medications were provided to R1, R4, and R8 that were signed off as administered.
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: Eva M Alvarez
LICENSING EVALUATOR NAME: Wendy Gibbs
LICENSING EVALUATOR SIGNATURE:

DATE: 03/12/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/12/2025
LIC9099 (FAS) - (06/04)
Page: 7 of 7