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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198602567
Report Date: 07/01/2025
Date Signed: 07/01/2025 04:51:14 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, 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
06/30/2025 and conducted by Evaluator Alfonso Iniguez
PUBLIC
COMPLAINT CONTROL NUMBER: 11-AS-20250630143653
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:
07/01/2025
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH: Monique Avila/Wellness Director.TIME COMPLETED:
05:00 PM
ALLEGATION(S):
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Facility staff failed to reassess resident properly.
INVESTIGATION FINDINGS:
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On 7/1/2025 at approximately 9:30 AM, LPA Alfonso Iniguez conducted an unannounced complaint visit. LPA Iniguez met 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: 7/1/25, Staff Roster dated: 6/17/25, Copy of (R#1)’s Physician’s Report for the Residential Care Facilities for the Elderly (RCFE) dated: 6/17/2025, Copy of (R#1) Service Plan dated:4/23/25.


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: 07/01/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/01/2025
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 2
Control Number 11-AS-20250630143653
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: 07/01/2025
NARRATIVE
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Investigation Revealed the Following:

Allegation: Facility staff failed to reassess resident properly

The details of the complaint alleged that facility staff failed to reassess (R#1) properly.

On July 1, 2025, at approximately 10:00 AM, during a records review, LPA Iniguez observed that (R#1) had a copy of their Physician's Report for the Residential Care Facilities for the Elderly (RCFE), specifically the LIC 602A form, dated June 17, 2025. Additionally, LPA Iniguez found that the LIC 602A form was completed and signed by (R#1)'s primary care physician (W#1), not by (S#1). In contrast, (S#1) completed the service plan for (R#1) dated April 23, 2025, but it was not signed by (R#1)’s Power of Attorney (POA).

On July 1, 2025, at approximately 2:00 PM, during interviews with facility staff (S#1), she stated that she did not complete (R#1)’s medical assessment or LIC 602A. Additionally, (S#1) stated that she only completed (R#1)’s care plan for the facility.

During this investigation, LPA 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: 07/01/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/01/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2