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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198602567
Report Date: 10/15/2025
Date Signed: 10/15/2025 04:31:01 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
12/09/2024 and conducted by Evaluator Elvira Gonzalez
PUBLIC
COMPLAINT CONTROL NUMBER: 11-AS-20241209124307
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: 71DATE:
10/15/2025
UNANNOUNCEDTIME BEGAN:
09:38 AM
MET WITH:Robert Jakini, Executive DirectorTIME COMPLETED:
05:00 PM
ALLEGATION(S):
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Staff did not provide adequate food service to residents in care.
Staff did not safeguard resident's personal items.
Staff did not meet residents' incontinence needs.
INVESTIGATION FINDINGS:
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On 10/15/25, the department conducted a subsequent complaint visit to further investigate the above-mentioned allegations and deliver findings. The department met with Robert Jackini, Executive Director, and explained the reason for the visit. The department was granted access to the facility.

The investigation consisted of the following: On 12/10/24, the department requested a copy of the staff roster, and resident roster. The department reviewed service records for resident #1 (R1) and collected copies of the following documents: Resident Lease Agreement, Service Plan, Resident Assessment, Preplacement Appraisal Information, Identification and Emergency Information, Physician’s Report, Resident Personal Property and Valuables, Admissions Orders, Resident Notes, Resident Care Plan, Unusual Incident/Injury Report, and Staff schedule (for the dates of 11/25/24-11/28/24). The department conducted interviews with witness #1 (W1) and staff #1 (S1).

CONTINUED ON LIC9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Elvira Gonzalez
LICENSING EVALUATOR SIGNATURE:

DATE: 10/15/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/15/2025
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 8
Control Number 11-AS-20241209124307
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: 10/15/2025
NARRATIVE
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Furthermore, the department conducted a tour of the facility and observed the residents to identify any signs of neglect, abuse or other immediate health and safety threats. On 12/12/24, the department conducted interviews with W1. On 12/13/24, the department conducted interviews with witness #2 (W2), S1. On 12/14/24, the department conducted interviews with W2. On 12/16/24, the department received Hospice Records from Valley Oaks Hospice, Inc. (dated: 12/01/24-12/16/24) for R1. On 12/19/24, the department received EMS records and 911 recording from Long Beach Fire Department. On 12/20/24, the department received the Death Certificate from R1 from Long Beach Department of Health and Human Services. On 12/24/24, the department conducted interviews with W2, and witness #3 (W3). On 12/26/24, the department conducted interviews with staff #2-#5 (S2-S5). On 12/17/24, the department conducted interviews with W1. On 12/31/24, the department conducted interviews with staff #6-S7 (S6-S7). On 01/06/25, the department conducted interviews with witness #4 (W4). On 01/07/25, the department conducted interviews with staff #8-#9 (S8-S9). On 01/09/25, the department conducted interviews with staff #10 (S10). On 01/13/25, the department received Home Health Records for R1 from Royal Majesty Home Care, Inc. On 01/14/25, the department conducted interviews with W1. On 01/15/25, the department received Medical Records from R1’s Gastroenterologist, SoCal Gastroenterology, Hospital Records from St. Mary Medical Center, and Medical Records from Provider 1st R1’s Primary Care Physician. On 01/28/25, the department conducted interviews with witness #5 (W5). On 01/31/25, the department conducted interviews with staff #11 (S11). On 02/03/25, the department conducted interviews with witness #6 (W6). On 02/04/25, the department conducted interviews with witness #7 (W7). On 02/06/25, the department conducted interviews with witness #8 (W8). On 02/10/25, the department conducted interviews with witness #9 (W9) and staff #12 (S12). On 02/11/25, the department conducted interviews with witness #10 (W10). On 02/12/25, the department conducted interviews with witness #11 (W11). On 02/14/25, the department conducted interviews with witness #12 (W12). On 02/19/25, the department conducted interviews with staff #13 (S13). On 02/21/25, the department conducted interviews with S1 and S4. On 02/25/25, the department conducted interviews with W1. On 02/28/25, the department conducted interviews with staff #14-#15 (S14-S15). On 03/07/25, the department received Imaging Records for R1 from St. Mary Medical Center. On 03/14/25, the department conducted interviews with W2. On 03/20/25, the department conducted interviews with witness #13 (W13). On 03/21/25, the department conducted interviews with witness #14-#15 (W14-W15). On 10/15/25, the department requested a copy of the staff roster, resident roster, and the facility menu. The department conducted interviews with staff #2 (S2), staff #16-#20 (S16-S20), and residents #2-#7 (R2- R7).
SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Elvira Gonzalez
LICENSING EVALUATOR SIGNATURE:

DATE: 10/15/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/15/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 8
Control Number 11-AS-20241209124307
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: 10/15/2025
NARRATIVE
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 The department was unable to interview R1, as R1 passed away. Furthermore, the department conducted a tour of the facility.

The investigation revealed the following: For the allegation: Staff did not provide adequate food service to residents in care. It is being alleged that the food is never cut up nor pureed for the residents that can’t manage a whole chicken breast or a sandwich they couldn’t hold. On 10/15/25, the department conducted interview with S2 and S16-S20. Of those interviewed, 6 out of 6 staff stated that residents are provided adequate food service based on their dietary needs or modified diets. 6 out of 6 staff stated there is enough caregivers to attend to residents during mealtimes.

On 10/15/25, the department interviewed R2-R7, and were unable to interview R1, as they passed away. Of those interviewed, 6 out 6 residents denied the allegation. 6 out of 6 residents said they do not have a special diet, and they eat what they want. 6 out of 6 residents said that staff does cut up, and puree residents food. 6 out of 6 residents stated there is enough caregivers to attend to residents during mealtimes.

During a review of records, the department observed two weeks of the facility menu. The menu offers a variety of meals throughout the day, such as breakfast, lunch, dinner, including protein, starch, vegetables, and fruits. A review the Staff Roster revealed that the facility has enough staff to meet the needs of the residents served.

The department conducted a tour of the facility and observed residents consuming a balanced lunch, which included chicken noodle soup, with a side of fruit, juice, and water. The kitchen was inspected, during which the department observed a five-day supply of perishable food and a seven- day supply of nonperishable food items were noted. The kitchen appeared clean, and no health or safety concerns were observed during the visit.

Based on the information gathered, interviews conducted, and records reviewed, the Department found no evidence to support the allegation mentioned above. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation, did or did not occur, therefore the allegation is Unsubstantiated.
SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Elvira Gonzalez
LICENSING EVALUATOR SIGNATURE:

DATE: 10/15/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/15/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 8
Control Number 11-AS-20241209124307
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: 10/15/2025
NARRATIVE
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Allegation: Staff did not safeguard resident's personal items. It is being alleged that three sets of bedding and towels were purchased prior to a resident moving into the facility, yet there were never any towels, including hand towels to wipe their hands on, and only one sheet on the residents bed. On 10/15/25, the department conducted interview with S2 and S16-S20. Of those interviewed, 6 out of 6 staff denied the allegation. 6 out of 6 staff said they are not aware of a resident missing bedding and towels. 6 out of 6 staff said that the facility provides the residents with basic bedding necessities.

On 10/15/25, the department interviewed R2-R7, and were unable to interview R1, as they passed away. Of those interviewed, 6 out of 6 residents said they haven’t had an issue with any of their belongings missing. 6 out of 6 residents said that the facility provides them with basic bedding necessities.

During a review of records, the department observed that R1’s Resident Personal/Property and Valuables form (signed/dated: 04/27/23) was blank and had no personal items listed.

Based on the information gathered, interviews conducted, and records reviewed, the Department found no evidence to support the allegation mentioned above. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation, did or did not occur, therefore the allegation is Unsubstantiated.

Allegation: Staff did not meet residents' incontinence needs. It is being alleged that there is a lack of changing incontinence at the facility. On 10/15/25, the department conducted interview with S2 and S16-S20. Of those interviewed, 6 out of 6 staff denied the allegation. 6 out of 6 staff stated that residents are checked on at least every two hour or as needed, and depending on their needs. 6 out of 6 staff said residents are not left in soiled briefs for an extended period of time.

On 10/15/25, the department interviewed R2-R7, and were unable to interview R1, as they passed away. Of those interviewed, 6 out of 6 residents said they do not require any assistance with toileting. 6 out of 6 residents said that staff check on them frequently. 6 out of 6 residents said they have not observed a resident left in soiled briefs for an extended period of time.
SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Elvira Gonzalez
LICENSING EVALUATOR SIGNATURE:

DATE: 10/15/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/15/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 8
Control Number 11-AS-20241209124307
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: 10/15/2025
NARRATIVE
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Based on the information gathered, interviews conducted, and records reviewed, the Department found no evidence to support the allegation mentioned above. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation, did or did not occur, therefore the allegation is Unsubstantiated.


An exit interview was conducted, and a copy of the report was provided to Robert Jakini, Executive Director.
SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Elvira Gonzalez
LICENSING EVALUATOR SIGNATURE:

DATE: 10/15/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/15/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 8