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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198602567
Report Date: 11/07/2025
Date Signed: 11/07/2025 12:04:12 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, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
This is an official report of an unannounced visit/investigation of a complaint received in our office on
02/06/2025 and conducted by Evaluator Socorro Leandro
COMPLAINT CONTROL NUMBER: 11-AS-20250206165106
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: 73DATE:
11/07/2025
UNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Administrator - Robert JakiniTIME COMPLETED:
12:30 PM
ALLEGATION(S):
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Resident sustained multiple falls resulting in a fracture due to a lack of supervision
Staff did not properly report incidents involving resident
INVESTIGATION FINDINGS:
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On 11/07/2025, Licensing Program Analysts (LPA) Socorro Leandro conducted an unannounced subsequent complaint investigation visit to deliver findings. LPA met with Administrator, Robert Jakini and the purpose of the visit was explained. LPA was granted entry to the facility.









Page 1 of 6
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Socorro Leandro
LICENSING EVALUATOR SIGNATURE:

DATE: 11/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/07/2025
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 13
Control Number 11-AS-20250206165106
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME: REGENCY PALMS LONG BEACH
FACILITY NUMBER: 198602567
VISIT DATE: 11/07/2025
NARRATIVE
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The investigation consisted of the following:

On 02/10/2025, the department requested and gathered Resident 1’s (R1) records. On 02/25/2025, the department interviewed Witness 5 (W5) and Witness 9 (W9). On 03/12/2025, the department interviewed Staff 1 (S1), Staff 2 (S2), Witness 10 (W10). The department interviewed/attempted to interview R1, Resident 11 (R11), Resident 19 (R19) and Resident 20 (R20). On 06/25/2025, the department interviewed W5 and Witness 11 (W11). On 10/16/2025, the department interviewed/attempted to interview residents, staff, and witnesses. The department interviewed/attempted to interview Resident 2 (R2) to Resident 18 (R18); R2 to Resident 10 (R10) were able to answer all questions; Resident 11 (R11) to Resident 12 (R12) were able to answer some questions; and Resident 13 (R13) to R18 were unable to answer questions. The department interviewed Staff 1 (S1) to Staff 5 (S5) and attempted to interview Staff 6 (S6). The department interviewed Witness 1 (W1) to W5 and attempted to interview W6 to Witness 14 (W14). Facility records were gathered and reviewed which consisted of Personnel Report dated 10/15/2025, Resident Roster, and Identification And Emergency Information records for R2 to R11. On 10/29/2025, the department interviewed/attempted to interview staff and witnesses. The department attempted to interview S6. The department interviewed W6 to Witness 8 (W8) and attempted to interview Witness 9 (W9) to W14.

Page 2 of 6

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Socorro Leandro
LICENSING EVALUATOR SIGNATURE:

DATE: 11/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/07/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 13
Control Number 11-AS-20250206165106
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME: REGENCY PALMS LONG BEACH
FACILITY NUMBER: 198602567
VISIT DATE: 11/07/2025
NARRATIVE
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The investigation revealed the following:

Allegation: “Resident sustained multiple falls resulting in a fracture due to a lack of supervision”, it is being alleged that on 12/31/2024 R1 had unwitnessed falls due to lack of supervision which resulted in a hip fracture. A review of R1’s medical and facility records revealed that R1 was a known fall risk who required significant assistance with mobility and Activities of Daily Living (ADLs). According to R1’s Individual Service Plan dated 7/3/2024, R1 required extensive assistance with mobility and toileting to prevent falls, and staff were directed to encourage and ensure the use of assistive devices such as walkers or canes. The Physician’s Report dated 8/19/2024, documented that R1 was non-ambulatory, required total assistance and supervision, and needed assistance with toileting. Similarly, R1’s Preplacement Appraisal Information dated 8/24/2024, indicated that R1 had a wobbly gait, needed physical assistance from another person for stability while walking, and required toileting assistance. According to medical records from St. Mary Medical Center-Long Beach, R1 was admitted to the hospital on 12/31/2024 and diagnosed with right hip fracture. Video surveillance from 12/31/2024, showed the following: at 7:35:24 a.m., R1 was seen walking toward the bathroom without an assistive device and without staff assistance, while an unidentified staff member stood nearby, looking at their phone near the bathroom door. At 7:35:44 a.m., R1 entered the bathroom alone. The staff member did not follow R1 and remained in place, still looking at their phone. At 7:36:05 a.m., a thump was heard, followed by R1 calling out, “Ay, ay, ay…”


Page 3 of 6
SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Socorro Leandro
LICENSING EVALUATOR SIGNATURE:

DATE: 11/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/07/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 13
Control Number 11-AS-20250206165106
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME: REGENCY PALMS LONG BEACH
FACILITY NUMBER: 198602567
VISIT DATE: 11/07/2025
NARRATIVE
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The staff member then approached and entered the bathroom at 7:36:08 a.m., where R1 could be heard saying, “Ay, ay, ay. I fell.” The staff member responded, “Oh my god, are you okay? You’re okay, you’re okay, honey.” At 8:00:42 a.m., video surveillance showed that R1’s walker was not within reach of the bed and that R1’s bedroom door was closed. At 8:00:44 a.m., R1 was observed getting out of bed, putting on slippers, and attempting to walk toward the walker. At 8:01:32 a.m., R1 fell onto the floor beside the bed and repeatedly called out, “Ay, ay, ay” for roughly two minutes. At 8:03:59 a.m., another staff member opened R1’s bedroom door, entered the room, and began assisting R1. Emergency personnel were later called, and R1 was transported to the hospital. Interviews conducted with staff members S1, S2, W5, and W9 confirmed that R1 was recognized by all four individuals as a fall risk who required frequent redirection and regular safety checks. Based on the evidence, on 12/31/2024, R1 did not receive the necessary assistance or care & supervision with mobility, transfers, and toileting as outlined in their care plan and medical documentation. The lack of appropriate supervision and failure to implement R1’s individualized care needs resulted in two consecutive falls on the same morning, ultimately leading to R1’s hospitalization and diagnosis of a hip fracture. Based on observations, interviews and record review(s), the preponderance of evidence standard has been met, therefore the above allegation(s) is found to be substantiated. California Code of Regulations, Title 22, Division 6 and Chapter 8 are being cited on the attached LIC 9099D. An immediate Civil Penalty of $500.00 is being assessed please see attached LIC421IM.


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SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Socorro Leandro
LICENSING EVALUATOR SIGNATURE:

DATE: 11/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/07/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 13
Control Number 11-AS-20250206165106
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME: REGENCY PALMS LONG BEACH
FACILITY NUMBER: 198602567
VISIT DATE: 11/07/2025
NARRATIVE
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Allegation: “Staff did not properly report incidents involving resident”, it is being alleged that the facility did not follow reporting requirements for unusual incidents/injuries that occurred to R1. A review of R1’s records revealed that R1 was admitted to St. Mary Medical Center-Long Beach on 12/31/2024 and discharged on 01/03/2024 with a diagnosis of right hip fracture and urinary tract infection. Video surveillance from 12/31/2024, showed that at approximately 8:01:32 a.m., R1 fell onto the floor beside the bed and repeatedly called out, “Ay, ay, ay” for roughly two minutes. At approximately 8:03:59 a.m., another staff member opened R1’s bedroom door, entered the room, and began assisting R1. At approximately 8:14:15 a.m., ambulance sirens were heard in the background. At approximately 8:20:20 a.m., two firefighters enter the room. A firefighter indicates that they will be taking R1 to the hospital. Interviews conducted with S1, S2, W5, W9, and W10 confirmed that R1 sustained a fall in 12/2024 which resulted in a hip fracture and facility staff called 911. A review of the department’s records, R1’s records, and emails between the department and W5 revealed that the facility did not submit a written report of the incident that occurred to R1 on 12/31/2024 to the department. Furthermore, department has not received an Unusual Incident/Injury Report (UIR) regarding the incident of R1 on 12/31/2024. Based on observations, interviews and record reviews, the preponderance of evidence standard has been met, therefore the above allegation is found to be substantiated. California Code of Regulations, Title 22, Division 6 and Chapter 8 are being cited on the attached LIC 9099D.



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SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Socorro Leandro
LICENSING EVALUATOR SIGNATURE:

DATE: 11/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/07/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 13
Control Number 11-AS-20250206165106
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME: REGENCY PALMS LONG BEACH
FACILITY NUMBER: 198602567
VISIT DATE: 11/07/2025
NARRATIVE
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At this time, an enhanced civil penalty determination is pending in reference to Health & Safety Code 1569.49(f)“Serious Bodily Injury” as defined in Section 243 of the Penal Code that states, a serious physical condition, including, but not limited to, the following: loss of consciousness; concussion; bone fracture; protracted loss or impairment of any bodily member or organ; a wound requiring extensive suturing; and serious disfigurement.”

An exit interview conducted with Administrator Robert Jakini, appeal rights explained and a copy of this report along with the Civil Penalty Assessment Form LIC 421IM and appeal rights were provided.












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SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Socorro Leandro
LICENSING EVALUATOR SIGNATURE:

DATE: 11/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/07/2025
LIC9099 (FAS) - (06/04)
Page: 6 of 13
Control Number 11-AS-20250206165106
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: REGENCY PALMS LONG BEACH
FACILITY NUMBER: 198602567
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/07/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/25/2025
Section Cited
CCR
87411(a)
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87411 Personnel Requirements - General (a) Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs. In facilities licensed for sixteen or more, sufficient support staff shall be employed to ensure provision of personal assistance and care as required in Section 87608, Postural Supports. Additional staff shall be employed as necessary to perform office work, cooking, house cleaning, laundering, and maintenance of buildings, equipment and grounds. The licensing agency may require any facility to provide additional staff whenever it determines through documentation that the needs of the particular residents, the extent of services provided, or the physical arrangements of the facility require such additional staff for the provision of adequate services.

This requirement is not met as evidenced by:
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The Administrator has agreed to re-read CCR87411, create a plan to be in compliance with CCR87411, and retrain staff on how to provide competent services necessary to meet residents’ needs while ensuring that staff provides personal assistance and care.
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Based on observations, interviews and record review, on 12/31/2024 during morning time staff did not provide competent services necessary to meet R1’s needs in ensuring that R1 received provisions of personal assistance and care which resulted in R1 having 2 unwitnessed falls and sustaining a hip fracture, which posed a potential health, safety or personal rights risk to persons in care.
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Email proof of correction to Socorro.Leandro@dss.ca.gov
Type B
11/25/2025
Section Cited
CCR
87211(a)(1)(B)
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87211 Reporting Requirements (a) Each licensee shall furnish to the licensing agency such reports as the Department may require, including, but not limited to, the following: (1) A written report shall be submitted to the licensing agency and to the person responsible for the resident within seven days of the occurrence of any of the events
specified in (A) through (D) below. This report shall include the resident's name, age, sex and date of admission; date and nature of event; attending physician's name, findings, and treatment, if any; and disposition of the case. (B) Any serious injury as determined by the attending physician and occurring while the resident is under facility supervision.

This requirement is not met as evidenced by:
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The Administrator has agreed to re-read CCR87211 Reporting Requirements, create a plan to be in compliance with CCR87211, and retrain staff on how to submit written reports to licensing.
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Based on observations, interviews and record review, the facility did not submit a written report to the department of a fall incident that occurred to R1 on 12/31/2024, that resulted to R1 having a hip fracture. The department has yet to receive an Unusual Incident/Injury Report of said incident on 12/31/2024 which posed a potential health, safety or personal rights risk to persons in care.
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Email proof of correction to Socorro.Leandro@dss.ca.gov
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: Ulysses Coronel
LICENSING EVALUATOR NAME: Socorro Leandro
LICENSING EVALUATOR SIGNATURE:

DATE: 11/07/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/07/2025
LIC9099 (FAS) - (06/04)
Page: 7 of 13
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
This is an official report of an unannounced visit/investigation of a complaint received in our office on
02/06/2025 and conducted by Evaluator Socorro Leandro
COMPLAINT CONTROL NUMBER: 11-AS-20250206165106

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: 73DATE:
11/07/2025
UNANNOUNCEDTIME BEGAN:
11:00 AM
MET WITH:Administrator - Robert JakiniTIME COMPLETED:
12:30 PM
ALLEGATION(S):
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Staff did not provide proper care to resident following hospital discharge
Staff spoke inappropriately to resident
Staff did not prevent a resident from physically assaulting another resident
Staff restrained resident
INVESTIGATION FINDINGS:
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On 11/07/2025, Licensing Program Analysts (LPA) Socorro Leandro conducted an unannounced subsequent complaint investigation visit to deliver findings. LPA met with Administrator Robert Jakini and the purpose of the visit was explained. LPA was granted entry to the facility.









Page 1 of 6
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Socorro Leandro
LICENSING EVALUATOR SIGNATURE:

DATE: 11/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/07/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 8 of 13
Control Number 11-AS-20250206165106
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME: REGENCY PALMS LONG BEACH
FACILITY NUMBER: 198602567
VISIT DATE: 11/07/2025
NARRATIVE
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The investigation consisted of the following: On 02/10/2025, the department requested and gathered Resident 1’s (R1) records. On 02/25/2025, the department interviewed Witness 5 (W5) and Witness 9 (W9). On 03/12/2025, the department interviewed Staff 1 (S1), Staff 2 (S2), Witness 10 (W10). The department interviewed/attempted to interview R1, Resident 11 (R11), Resident 19 (R19) and Resident 20 (R20). On 06/25/2025, the department interviewed W5 and Witness 11 (W11). On 10/16/2025, the department interviewed/attempted to interview residents, staff, and witnesses. The department interviewed/attempted to interview Resident 2 (R2) to Resident 18 (R18); R2 to Resident 10 (R10) were able to answer all questions; Resident 11 (R11) to Resident 12 (R12) were able to answer some questions; and Resident 13 (R13) to R18 were unable to answer questions. The department interviewed Staff 1 (S1) to Staff 5 (S5) and attempted to interview Staff 6 (S6). The department interviewed Witness 1 (W1) to W5 and attempted to interview W6 to Witness 14 (W14). Facility records were gathered and reviewed which consisted of Personnel Report dated 10/15/2025, Resident Roster, and Identification And Emergency Information records for R2 to R11. On 10/29/2025, the department interviewed/attempted to interview staff and witnesses. The department attempted to interview S6. The department interviewed W6 to Witness 8 (W8) and attempted to interview Witness 9 (W9) to W14.





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SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Socorro Leandro
LICENSING EVALUATOR SIGNATURE:

DATE: 11/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/07/2025
LIC9099 (FAS) - (06/04)
Page: 9 of 13
Control Number 11-AS-20250206165106
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME: REGENCY PALMS LONG BEACH
FACILITY NUMBER: 198602567
VISIT DATE: 11/07/2025
NARRATIVE
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The investigation revealed the following:

Allegation: “Staff did not provide proper care to resident following hospital discharge”, it is being alleged that staff did not follow doctors order for Resident 1 following their hospital discharge on 01/03/2025. Interviews conducted with R2 to R12 revealed the following: 9 out of 11 residents denied the allegation and 2 out of 11 residents were unable to answer the questions. Interviews conducted with S1 to S5 revealed the following: 5 out of 5 staff denied the allegation. Interviews conducted with W1 to W9 revealed the following: 9 out of 9 witnesses denied the allegation. R1’s hospital discharge records dated 12/31/2024 to 01/03/2025 revealed the following: R1’s discharge plan included “regular diet” and “Discharge Activity as tolerated” signed by Medical Doctor on 01/03/2025. There are no records indicating that R1 did not follow the hospital discharge orders. R1’s hospital record of “Discharge Instructions Document” dated 12/31/2024 revealed the following: “General instructions” provided for “Urinary Tract Infection” and “Hip Fracture” and “Fall Prevention in the Home”; there is no documentation indicating that said instructions were not followed. 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.



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SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Socorro Leandro
LICENSING EVALUATOR SIGNATURE:

DATE: 11/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/07/2025
LIC9099 (FAS) - (06/04)
Page: 10 of 13
Control Number 11-AS-20250206165106
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME: REGENCY PALMS LONG BEACH
FACILITY NUMBER: 198602567
VISIT DATE: 11/07/2025
NARRATIVE
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Allegation: “Staff spoke inappropriately to resident”, it is being alleged that staff spoke inappropriately to R1. Interviews conducted with R2 to R12 revealed the following: 11 out of 11 residents denied the allegation. Interviews conducted with S1 to S5 revealed the following: 5 out of 5 staff denied the allegation. Interviews conducted with W1 to W8 revealed the following: 7 out of 8 witnesses denied the allegation and 1 out of 8 witnesses agreed with the allegation. Observations on 02/10/2025 and 10/16/2025 revealed the following: staff were observed treating residents with dignity and respect. Video surveillance dated 01/04/2025 at 22:40:43 did not indicate that staff spoke inappropriately to R1. Records reviewed of Unusual Incident/Injury Reports and Resident Notes: do not indicate that staff have spoken to residents inappropriately. 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.











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SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Socorro Leandro
LICENSING EVALUATOR SIGNATURE:

DATE: 11/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/07/2025
LIC9099 (FAS) - (06/04)
Page: 11 of 13
Control Number 11-AS-20250206165106
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME: REGENCY PALMS LONG BEACH
FACILITY NUMBER: 198602567
VISIT DATE: 11/07/2025
NARRATIVE
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Allegation: “Staff did not prevent a resident from physically assaulting another resident”, it is being alleged that staff did not prevent R1 from being physically assaulted by their roommate. Interviews conducted with R2 to R12 revealed the following: 11 out of 11 residents denied the allegation. Interviews conducted with S1 to S5 revealed the following: 5 out of 5 staff denied the allegation. Interviews conducted with W1 to W8 revealed the following: 8 out of 8 witnesses denied the allegation, moreover, witnesses indicated that staff separate residents that don’t like each other. Review of the video surveillance obtained of two incidents that occurred in R1’s room on 12/6/2024 at 14:29:53 and 12/13/2024 at 18:22:37 in which the R1 and their roommate had an altercation. When staff entered the room, the incidents were deescalated, staff did not witness physical altercations between residents, and staff were unaware of the full details of the incidents at both times. Staff did deescalate the situation, re-directed residents, and separate residents. Unusual Incident/Injury Report regarding physical altercation between R1 and their roommate dated 12/31/2024 revealed the following: the facility discussed residents moving into a different room with residents responsible person; R1’s responsible person did not want R1 to move to another room; staff had an in-service about monitoring residents and redirecting residents; staff were also directed to do frequent monitoring during night shift. 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.



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SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Socorro Leandro
LICENSING EVALUATOR SIGNATURE:

DATE: 11/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/07/2025
LIC9099 (FAS) - (06/04)
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Control Number 11-AS-20250206165106
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME: REGENCY PALMS LONG BEACH
FACILITY NUMBER: 198602567
VISIT DATE: 11/07/2025
NARRATIVE
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Allegation: “Staff restrained resident”, it is being alleged that on 01/2025 (exact date unknown) a staff member restrained R1 to their bed by using a waist belt. Interviews conducted with R2 to R12 revealed the following: 10 out of 11 residents denied the allegation and 1 out of 11 residents were unable to answer the question. Interviews conducted with S1 to S5 revealed the following: 5 out of 5 staff denied the allegation, furthermore, staff indicated that they have not placed restraints on residents or seen staff restrain a resident. Interviews conducted with W1 to W8 revealed the following: 8 out of 8 witnesses denied the allegation, moreover, witnesses indicate that they have not seen/heard about staff restrain residents. R1’s records reviewed: there is no documentation or video surveillance footage indicating that staff restrained R1. 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 this report was provided to Administrator Robert Jakini.







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SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Socorro Leandro
LICENSING EVALUATOR SIGNATURE:

DATE: 11/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/07/2025
LIC9099 (FAS) - (06/04)
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