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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198602567
Report Date: 06/18/2025
Date Signed: 06/18/2025 05:18:04 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
06/09/2025 and conducted by Evaluator Alfonso Iniguez
PUBLIC
COMPLAINT CONTROL NUMBER: 11-AS-20250609165123
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: 75DATE:
06/18/2025
UNANNOUNCEDTIME BEGAN:
09:42 AM
MET WITH:Fabiola Marciano/Executive DirectorTIME COMPLETED:
04:45 PM
ALLEGATION(S):
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Resident not assisted with medications as prescribed.
INVESTIGATION FINDINGS:
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On 6/18/2025 at approximately 10:00 AM, LPA Alfonso Iniguez conducted an unannounced complaint visit. LPA Iniguez met with Fabiola Marciano/Executive Director then later with Monique Avila/Wellness Director. LPA Iniguez explained the purpose of this visit.

Investigation Consisted of: LPA conducted the following interviews: Staff Interviews (S#1). LPA obtained and reviewed the following documents: Resident Roster dated: 6/18/25, Staff Roster dated: 6/17/25,Copy of (R#1)’s prescription order for Seroquel (Quetiapine Fumarate 50 MG Tab) dated:1/20/25, Copy of (R#1)’s Physicians Report for Residential Care Facilities for the Elderly (RCFE) or LIC 602A dated: 2/12/25, Copy of (R#1)’s Medication Administration Record (MARs) for June 2025, and copy of (R#1) video recording dated: 6/8/25 at approximately 10:30 pm.


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: 06/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/18/2025
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 4
Control Number 11-AS-20250609165123
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: 06/18/2025
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 staff is not giving (R#1) medication as prescribed by their physician.



On June 18, 2025, at approximately 2:00 PM, during a records review, LPA Iniguez observed (R#1) 's prescription order for Seroquel (Quetiapine Fumarate 50 MG Tab), dated 1/20/25. The order specifies a time of 8:00 PM to administer this medication at nighttime. Additionally, LPA Iniguez observed (R#1)'s Medication Administration Record (MAR) for June 2025. LPA Iniguez observed that on 6/8/25, facility staff marked down the medication given to (R#1) at 8:00 PM. Also, the (MARs) extra notes for 6/8/25 do not show (R#1) refused the medication. However, LPA Iniguez observed a video recording obtained by the department with a time stamp of 2025/6/8 at approximately 10:32 PM. The video shows (S#2) waking up (R#1) and administering the medication that was supposed to be given at 8:00 PM, as per the doctor's order. In addition, LPA Iniguez reviewed (R#1) 's Physician's Report for Residential Care Facilities for the Elderly (RCFE) or LIC 602A, dated 2/12/25. It was confirmed that (R#1) is unable to administer or store their own medications.


On June 18, 2025, at approximately 02:00 PM, during interviews with facility staff (S#1), she stated that on 6/8/25 at approximately 10:32 PM, (S#2) forgot to give (R#1) medication at 8:00 PM. (S#1) instructed (S#2) to administer the medication to (R#1) at that time.

Evaluation Report continues LIC 9099-C

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

DATE: 06/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/18/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 11-AS-20250609165123
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: 06/18/2025
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: 06/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/18/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 11-AS-20250609165123
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: 06/18/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/30/2025
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 a disciplinary action for (S#2) and re-training on medication managment. Proof of correction will be sent to LPA Iniguez via email before 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 as per the doctor's order. 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: 06/18/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/18/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 4