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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198602567
Report Date: 03/19/2021
Date Signed: 04/01/2021 08:39:45 AM



STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE DR #100
MONTERY PARK, CA 91754
This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/29/2020 and conducted by Evaluator Susan Campos
PUBLIC
COMPLAINT CONTROL NUMBER: 11-AS-20200729115548
FACILITY NAME:REGENCY PALMS LONG BEACHFACILITY NUMBER:
198602567
ADMINISTRATOR:CHRISTINE TOMLINSONFACILITY TYPE:
740
ADDRESS:117 E 8TH STREETTELEPHONE:
(562) 432-9260
CITY:LONG BEACHSTATE: CAZIP CODE:
90813
CAPACITY:91CENSUS: 51DATE:
03/19/2021
UNANNOUNCEDTIME BEGAN:
03:43 PM
MET WITH:Carla MarianoTIME COMPLETED:
05:00 PM
ALLEGATION(S):
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Staff are not meeting the residents needs.
Staff did not safeguard residents personal belongings.
INVESTIGATION FINDINGS:
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On 3/19/2021, Licensing Program Analyst (LPA)/Susan Campos, initiated a subsequent complaint investigation visit to deliver findings for the allegations listed above. Due to the situation surrounding the Coronavirus Disease 2019 (COVID-19), and to implement mitigation measures, today’s subsequent complaint investigation was conducted telephonically with Carla Mariano, Administrator. The investigation consisted of the following: LPA conducted telephone interviews with (8) staff members and video conference calls with (8) residents. In addition, a telephone/video inspection of the facilities’ physical plant and food supply, for health and safety. The areas covered, in the teleconference inspection, included: common areas: reception area and front door, living/ dining room, kitchen, and food supply. In addition, the LPA reviewed the following documents submitted by Regency Palms Long Beach Administrator Mariano: Admission Agreement, Training documents, Admission Agreement, Staff (LVN and caregiver) work duties, Caregiver's resident service duties, and checklist, Client's Personal Property Form, Client's Loss/ Theft procedures for personal belongings, Caregiver Training Program Plan, and Resident laundry service procedures, R1-R8 Physician Reports, R1-R8 Case Notes, R1-R8 Needs Assessment, and S1-S8 Employment Application, and S1-S8 Training Documents.

Report continued on LIC9099C
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Eva M AlvarezTELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Susan CamposTELEPHONE: (323) 629-7445
LICENSING EVALUATOR SIGNATURE:

DATE: 03/19/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/19/2021
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
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE DR #100
MONTERY PARK, CA 91754
This is an official report of an unannounced visit/investigation of a complaint received in our office on
07/29/2020 and conducted by Evaluator Susan Campos
COMPLAINT CONTROL NUMBER: 11-AS-20200729115548

FACILITY NAME:REGENCY PALMS LONG BEACHFACILITY NUMBER:
198602567
ADMINISTRATOR:CHRISTINE TOMLINSONFACILITY TYPE:
740
ADDRESS:117 E 8TH STREETTELEPHONE:
(562) 432-9260
CITY:LONG BEACHSTATE: CAZIP CODE:
90813
CAPACITY:91CENSUS: 51DATE:
03/19/2021
UNANNOUNCEDTIME BEGAN:
03:43 PM
MET WITH:Carla MarianoTIME COMPLETED:
05:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff not properly trained.
INVESTIGATION FINDINGS:
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13
On 3/19/2021, Licensing Program Analyst (LPA)/Susan Campos, initiated a subsequent complaint investigation visit to deliver findings for the allegations listed above. Due to the situation surrounding the Coronavirus Disease 2019 (COVID-19), and to implement mitigation measures, today’s subsequent complaint investigation was conducted telephonically with Carla Mariano, Administrator. The investigation consisted of the following: LPA conducted telephone interviews with (8) staff members and video conference calls with (8) residents. In addition, a telephone/video inspection of the facilities’ physical plant and food supply, for health and safety. The areas covered, in the teleconference inspection, included: common areas: reception area and front door, living/ dining room, kitchen, and food supply. In addition, the LPA reviewed the following documents submitted by Regency Palms Long Beach Administrator Mariano: Admission Agreement, Training documents, Admission Agreement, Staff (LVN and caregiver) work duties, Caregiver's resident service duties, and checklist, Client's Personal Property Form, Client's Loss/ Theft procedures for personal belongings, Caregiver Training Program Plan, and Resident laundry service procedures, R1-R8 Physician Reports, R1-R8 Case Notes, R1-R8 Needs Assessment, and S1-S8 Employment Application, and S1-S8 Training Documents.

Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Eva M AlvarezTELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Susan CamposTELEPHONE: (323) 629-7445
LICENSING EVALUATOR SIGNATURE:

DATE: 03/19/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/19/2021
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 7
Control Number 11-AS-20200729115548
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE DR #100
MONTERY PARK, CA 91754
FACILITY NAME: REGENCY PALMS LONG BEACH
FACILITY NUMBER: 198602567
VISIT DATE: 03/19/2021
NARRATIVE
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Allegation: Staff not properly trained.

The investigation revealed, per LPA interviews, with (8) staff members, and (8) residents from the Regency Palms Long Beach facility and R1’s family member, and review of facility documents, that the Regency Palms Long Beach facility did provide proper trained. LPA interviewed S1, and was informed that the facility provides the required hours of training for caregivers, and also has a shadow hand on training, in addition, up to date training, that in constant. S1 provided LPA with staff training plan, modules, and training material. In addition, training material for shadowing. S1 informed LPA that the training curriculum is standard for the Meridian company. LPA interviewed 8 staff members, and 8 of 8 staff members informed LPA that they were provided training when they started their new position in the company. Also 8 of 8 staff members informed LPA that they believe that their training is sufficient to do their job. LPA interviewed 8 resident, and 8 of 8 residents informed LPA that help them when needed.

Based on information gathered, LPA did not find sufficient evidence to support allegation "Staff not properly trained ”

Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are Unsubstantiated.

A telephonic exit interview was conducted with Carla Mariano, Administrator, and a hard copy of a LIC 9099 was provided via email for signature.




SUPERVISOR'S NAME: Eva M AlvarezTELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Susan CamposTELEPHONE: (323) 629-7445
LICENSING EVALUATOR SIGNATURE:

DATE: 03/19/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/19/2021
LIC9099 (FAS) - (06/04)
Page: 3 of 7
Control Number 11-AS-20200729115548
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE DR #100
MONTERY PARK, CA 91754
FACILITY NAME: REGENCY PALMS LONG BEACH
FACILITY NUMBER: 198602567
VISIT DATE: 03/19/2021
NARRATIVE
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Allegation: Staff are not meeting the residents needs

The investigation revealed, per LPA interviews, with (8) staff members, and (8) residents from Regency Palms Long Beach facility, and R1’s family member that facility did not meet the needs of the residents. S1 informed LPA, that the facility caregivers are assigned, to conduct daily tasks, to ensure that the residents needs are cared for. These tasks will include providing specific hygiene care to the residents. Each caregiver is assigned residents, and a resident schedule, for hygiene services, such as showers. LPA interviewed 8 staff members, and 8 of 8 staff members, informed LPA, that the caregivers are assigned residents to care for. Also, 8 of 8 staff, interviewed informed LPA, that they service the residents needs. As part of the investigation, LPA reviewed case notes, from R1’s facility case file. Case note states that on 12/24/2019, R1’s family member, informed S1 that “…expects R1 to be shaved, hair combed, teeth brushed & wearing nice clean clothes. I expect R1 to have a fresh depends on, and hearing aids with fresh batteries in them". Per R1's family member, the last time, picked R1 up, family member, stated that "R1 looked like a homeless person that had slept all night in same clothes.” S1 informed LPA, that S1 did address R1's family concerns, and that the issue is resolved. In addition, on 8/14/2020, LPA also conducted a teleconference - face time visit with 8 facility residents. LPA observed 8 residents, in the facility, and determined that 6 of 8 residents, living in the facility, had fingernails, on both hands, that were, approximately 1/2 to 1 inch long on each hand, with specs of nail polish, on the finger nail. Also, R1's family member, provided a picture of R1 with finger nails on both hands approximately 1/2 inch long, and with one finger nail chipped at the corner.

On 8/14/20, LPA observed 6 residents finger nails untrimmed and not groomed, and also on 8/14/20, LPA observed R1 photograph, approximately 1/2 inch long finger nails, that were not groomed.

Based on information gathered, LPA did find sufficient evidence to support allegation
"Staff are not meeting the resident’s needs”

Report continued on LIC9099C
SUPERVISOR'S NAME: Eva M AlvarezTELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Susan CamposTELEPHONE: (323) 629-7445
LICENSING EVALUATOR SIGNATURE:

DATE: 03/19/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/19/2021
LIC9099 (FAS) - (06/04)
Page: 5 of 7
Control Number 11-AS-20200729115548
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE DR #100
MONTERY PARK, CA 91754
FACILITY NAME: REGENCY PALMS LONG BEACH
FACILITY NUMBER: 198602567
VISIT DATE: 03/19/2021
NARRATIVE
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On 4/15/21 LPA amended LIC 9099C to delete statements not part of LIC9099C. The allegation is still substantiated.

Allegation: Staff did not safeguard resident’s personal belongings

The investigation revealed, per LPA interviews with Regency Palms Long Beach (8) staff persons, (8) residents, and R1’s family member, that staff did not safeguard resident’s personal belongings. S1 informed LPA that the facility caregivers launder the resident's clothes, and place them back in the resident's room closet and chest drawers. The washer and dryer, is on the same floor, where the residents live. S1 states that the caregivers assist the residents in picking up and putting away personal items. S1 states that the caregivers, at the facility, have been provided with laundering training, and instructions on how to use the washer and dryer effectively. In addition, S1 stated that the laundry room, has instructions, on the machine to assist the caregiver, on how to use. S1 informed LPA, that was aware of R1's family concerns, regarding the condition of R1's clothes. S1 informed LPA, that due to their concerns, S1 provided R1's family member, with a monetary credit towards, R1's facility monthly rental fees. LPA interviewed 8 staff members, and 8 of 8 staff members informed LPA that they launder the resident's clothes, and place the clothes back in the clients' closet, and storage area. In addition, 8 of 8 staff member, also informed LPA that they have been trained, on how, to launder resident's clothes. LPA interviewed 8 residents, and 8 of 8 residents, informed LPA that they do not have problems with their clothes.

On 8/14/20, S1 informed LPA, that provided R1's family member, with rent credit, because R1's clothing items were destroyed during caregiver's laundering.

Based on information gathered, LPA did find sufficient evidence to support allegation "Staff did not safeguard resident’s personal belongings”

Report continued on LIC9099C
SUPERVISOR'S NAME: Eva M AlvarezTELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Susan CamposTELEPHONE: (323) 629-7445
LICENSING EVALUATOR SIGNATURE:

DATE: 03/19/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/19/2021
LIC9099 (FAS) - (06/04)
Page: 4 of 7
Control Number 11-AS-20200729115548
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE DR #100
MONTERY PARK, CA 91754
FACILITY NAME: REGENCY PALMS LONG BEACH
FACILITY NUMBER: 198602567
VISIT DATE: 03/19/2021
NARRATIVE
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Based on LPA observations and interviews which were conducted and record reviews, the preponderance of evidence standard has been met, therefore the above allegations are found to be substantiated. California Code of Regulations, Title 22, Division (6) and Chapter (8) are being cited on the attached LIC 9099D.

A telephonic exit interview was conducted with Carla Mariano, Administrator, and a hard copy of a LIC 9099 and LIC 9099D was provided via email for signature.
SUPERVISOR'S NAME: Eva M AlvarezTELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Susan CamposTELEPHONE: (323) 629-7445
LICENSING EVALUATOR SIGNATURE:

DATE: 03/19/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/19/2021
LIC9099 (FAS) - (06/04)
Page: 6 of 7
Control Number 11-AS-20200729115548
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE DR #100
MONTERY PARK, CA 91754

FACILITY NAME: REGENCY PALMS LONG BEACH
FACILITY NUMBER: 198602567
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/19/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/19/2021
Section Cited
CCR
87307(a)(3)(F)
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87307(a)(3)(F)Personal Accommodations and Services(a)Living accommodations and grounds shall be related to the facility's function. The facility shall be large enough to provide comfortable living accommodations and privacy for the residents, staff, and others who may reside in the facility. The following provisions shall apply:(3)Equipment and supplies necessary for personal care and maintenance of adequate hygiene practice shall be readily available to each resident. The resident may provide the following items; however, if the resident is unable or chooses not to provide them, the licensee shall assure provision of: (F)Basic laundry service (washing, drying, and ironing of personal clothing).

This requirement is not met as evidenced by:
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Administrator will provide LPA a facility staff procedures on safe guarding resident’s laundry items, including instructions on how to use the washer and dryer machine.

All items will be faxed to DSS-CCL fax number (323) 981-1781
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Based on interviews, record review, and R1's photographs, the licensee failed to ensure during laundry service, that R1's new clothing items not be damaged, which posed a potential health risk to residents in care.
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Type B
03/19/2021
Section Cited
CCR
87468.2(a)(4)
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87468.2(a)(4)Additional Personal Rights of Residents in Privately Operated Facilities(a)In addition to the rights listed in Section 87468.1, Personal Rights of Residents in All Facilities, residents in privately operated residential care facilities for 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 is not met as evidenced by:
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Administrator will provide LPA with a copy of procedures and also schedule for resident's finger nail trimming and grooming.
All items will be faxed to DSSCCL fax number (323) 981-1781

POC Due Date is 4/1/2021
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Based on interviews, record review, and photographs, the licensee failed to ensure that resident’s finger nails, were not groomed, and trimmed as evidenced by photograph of R1's finger nails, and also per LPA video conference observation on 8/14/20, whereby LPA observed 7 of 8 residents with over ½ inch long finger nails not groomed, which posed a potential health 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: Eva M AlvarezTELEPHONE: (323) 629-7047
LICENSING EVALUATOR NAME: Susan CamposTELEPHONE: (323) 629-7445
LICENSING EVALUATOR SIGNATURE:

DATE: 03/19/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/19/2021
LIC9099 (FAS) - (06/04)
Page: 7 of 7