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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198602567
Report Date: 05/29/2025
Date Signed: 05/29/2025 05:01:55 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
05/22/2025 and conducted by Evaluator Alfonso Iniguez
COMPLAINT CONTROL NUMBER: 11-AS-20250522130604
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:
05/29/2025
UNANNOUNCEDTIME BEGAN:
09:28 AM
MET WITH:Monique Avila/Wellness DirectorTIME COMPLETED:
05:00 PM
ALLEGATION(S):
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Resident not assisted with medications as prescribed.

INVESTIGATION FINDINGS:
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On 5/29/2025 at approximately 9:30 AM, LPA Alfonso Iniguez conducted an unannounced complaint visit. LPA Iniguez met with Fabiola Marciano/Executive Director and later with Monique Avila/Wellness Director. LPA Iniguez explained the purpose of this visit.

Investigation Consisted of: LPA conducted the following interviews: Executive Director(A#1), Staff Interviews (S#1-S#3). LPA obtained and reviewed the following documents: Resident Roster dated: 5/29/25, Staff Roster dated: 5/12/25, (R#1-R#4) Physicians Report for Residential Care Facilities for the Elderly (RCFE) or LIC 602A dated: 8/18/24, 4/5/25, 3/7/24 and 4/22/25, and (R#1)’s Copies of Medication Administration (MARs) for March, April and May of 2025.


Evaluation Report continues LIC 9099-C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Alfonso Iniguez
LICENSING EVALUATOR SIGNATURE:

DATE: 05/29/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/29/2025
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-20250522130604
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: 05/29/2025
NARRATIVE
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Investigation Revealed the Following:

Allegation: Resident not assisted with medications as prescribed.

The details of the complaint alleged that facility did not follow (R#1)’s prescribed medications order.



On May 29, 2025, at approximately 3:00 PM, during a records review, LPA Iniguez observed Resident #1's Medication Administration Records (MARs) for April 2025. LPA Iniguez noted that the medication order for Ferrous Sulfate 325 MG Tablet prescribed one tablet to be taken by mouth once daily on Mondays, Wednesdays, and Fridays until April 23, 2025, when the physician discontinued it. However, facility staff documented on the MARs that they administered the medication to (R#1) for nine consecutive days, from April 14, 2025 (Monday) to April 22, 2025 (Tuesday). LPA Iniguez found that facility staff did not follow the prescribed medication order for (R #1). Moreover, LPA Iniguez reviewed (R#1)’s Physicians Report for Residential Care Facilities for the Elderly (RCFE) or LIC 602A dated: 8/19/24, it is noted that (R#1) is not able to administer their own prescribed medications.

On May 29, 2025, at approximately 10:00 AM, during an interview with the Administrator (A#1), she stated that there is an ongoing investigation to determine why the facility did not follow up on the order.

On May 29, 2025, at approximately 2:00 PM, interviews with facility staff (S#1-S#3) revealed that all (3) staff members did not follow up on (R#1)’s medication order prescribed by their physician.

Evaluation Report continues LIC 9099-C

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Alfonso Iniguez
LICENSING EVALUATOR SIGNATURE:

DATE: 05/29/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/29/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 7
Control Number 11-AS-20250522130604
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: 05/29/2025
NARRATIVE
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During this investigation, LPA found sufficient evidence to support the above-mentioned allegation.

Based on the evidence gathered, interviews conducted, and records reviewed, the preponderance of evidence standard has been met; therefore, the above-mentioned allegation is found to be SUBSTANTIATED.

California Code of Regulations (Title 22, Division 6, Chapter 8), the above-mentioned deficiency was observed, and citation issued (ref. LIC 9099D).

An exit interview was conducted, and a copy of the Complaint Report was given to Monique Avila/Wellness Director.

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Alfonso Iniguez
LICENSING EVALUATOR SIGNATURE:

DATE: 05/29/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/29/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 7
Control Number 11-AS-20250522130604
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: 05/29/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/16/2025
Section Cited
CCR
87465(a)(4)
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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 for assistance in obtaining such care, by compliance with the following: (4) The licensee shall assist residents with self-administered medications as needed.
This requirement was not met as evidence by:
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Licensee will adhere to Title 22 at all times. As plan of correction the facility will re-train staff on how to document correctly on the MARs. Proof of training will be sent to LPA Iniguez via email before the POC due date.
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Based on observation and record review, facility staff failed to ensure medication for (R#1) was not administered accurately. This poses a potential 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.
SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Alfonso Iniguez
LICENSING EVALUATOR SIGNATURE:

DATE: 05/29/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/29/2025
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, 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
05/22/2025 and conducted by Evaluator Alfonso Iniguez
COMPLAINT CONTROL NUMBER: 11-AS-20250522130604

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:
05/29/2025
UNANNOUNCEDTIME BEGAN:
09:28 AM
MET WITH:Fabiola Marciano/Executive DirectorTIME COMPLETED:
05:00 PM
ALLEGATION(S):
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Facility allowed resident t to be restrained
INVESTIGATION FINDINGS:
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On 5/29/2025 at approximately 9:30 AM, LPA Alfonso Iniguez conducted an unannounced complaint visit. LPA Iniguez met with Fabiola Marciano/Executive Director and Monique Avila/Wellness Drector. LPA Iniguez explained the purpose of this visit.

Investigation Consisted of: LPA conducted the following interviews: Executive Director(A#1), Staff Interviews (S#1-S#3), Resident’s interviews (R#1-R#7). LPA obtained and reviewed the following documents: Resident Roster dated: 5/29/25, Staff Roster dated: 5/12/25, (R#1-R#4) Physicians Report for Residential Care Facilities for the Elderly (RCFE) or LIC 602A dated: 8/18/24, 4/5/25, 3/7/24 and 4/22/25, (R#1)’s Copies of Nurse Practitioner (NP) orders dated: 1/9/25, 1/14/25 and 2/7/25.


Evaluation Report continues LIC 9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Alfonso Iniguez
LICENSING EVALUATOR SIGNATURE:

DATE: 05/29/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/29/2025
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-20250522130604
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: 05/29/2025
NARRATIVE
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Investigation Revealed the Following:

Allegation: Facility allowed resident t to be restrained.

The details of the complaint alleged that facility did not follow (R#1)’s doctors’ orders on restrains.



On May 29, 2025, at approximately 3:00 PM, during a records review, LPA Iniguez examined the facility file for (R#1). Within this file, LPA Iniguez found copies of Nurse Practitioner (NP) orders related to restraints. The first order dated January 9, 2025, states that it is permissible for (R#1)’s family to apply a nighttime restraint, provided by (R#1)’s family. The family assumes responsibility for any adverse occurrences and risks discussed with the care facility. Additionally, LPA Iniguez found another NP restraint order dated February 7, 2025, which instructs to discontinue all restraints that had been placed on (R#1) by the family.

On May 29, 2025, at approximately 10:00 a.m., during an interview with the Administrator (A#1), she stated that the facility always follows the orders of the residents’ doctors or Nurse Practitioners. In addition, (A#1) stated that yes, we follow the Nurse Practitioner (NP) order for restraints regarding (R#1). The family is supposed to put the restraints on at night, and we will remove them in the morning. The order was discontinued by the (NP) after a month.

On May 29, 2025, at approximately 3:00 PM, during interviews with residents (R#1-R#7), (7) out of (7) stated that they received their medical orders from their physician here at the facility. Additionally, (7) out of (7) residents in care stated that they believe the facility staff follow the orders as prescribed by their physician.



On May 29, 2025, at approximately 1:00 PM, during interviews with facility staff (S#1-S#3), (3) out of (3) stated that (R#1) had a prescribed order for restrains. They followed the order as noted by the Nurse Practitioner (NP) until it was discontinued on 2/7/25.

Evaluation Report continues LIC 9099-C
SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Alfonso Iniguez
LICENSING EVALUATOR SIGNATURE:

DATE: 05/29/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/29/2025
LIC9099 (FAS) - (06/04)
Page: 6 of 7
Control Number 11-AS-20250522130604
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: 05/29/2025
NARRATIVE
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During this investigation, LPA found did not find sufficient evident to support the above-mentioned allegation(s).

Based on the evidence gathered, interviews conducted, and records reviewed, the preponderance of evidence standard has been met; therefore, the above-mentioned allegation(s) are found to be UNSUBSTANTIATED.

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



An exit interview was conducted, and a copy of the Complaint Report was given to Monique Avila/Wellness Director.


SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Alfonso Iniguez
LICENSING EVALUATOR SIGNATURE:

DATE: 05/29/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/29/2025
LIC9099 (FAS) - (06/04)
Page: 7 of 7