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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198602567
Report Date: 12/16/2024
Date Signed: 12/16/2024 10:15:13 AM

Document Has Been Signed on 12/16/2024 10:15 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		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 BEACHFACILITY NUMBER:
198602567
ADMINISTRATOR/
DIRECTOR:		KENIA SANCHEZ PADILLAFACILITY TYPE:
740
ADDRESS:117 E 8TH STREETTELEPHONE:
(562) 432-9260
CITY:LONG BEACHSTATE: CAZIP CODE:
90813
CAPACITY: 91CENSUS: 64DATE:
12/16/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:32 AM
MET WITH:Fabiola Mariano, AdministratorTIME VISIT/
INSPECTION COMPLETED:
10:15 AM
NARRATIVE
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On 12/16/24, Licensing Program Analyst (LPA) Felisa Shirley visited this facility to investigate a complaint and upon investigation learned that facility staff are not answering the pull cord alert which alerts staffs attention to residents requesting for assistance in a timely manner. The LPA met with Robin Walker, Resident Care Coordinator, and the purpose for the visit was discussed. LPA Shirley interviewed 7 staff members and 7 residents.


Deficiencies cited under California Code of Regulations Title 22

Exit Interview Conducted with Administrator Fabiola Mariano.
SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Felisa Shirley
LICENSING EVALUATOR SIGNATURE: DATE: 12/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/16/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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Document Has Been Signed on 12/16/2024 10:15 AM - It Cannot Be Edited


Created By: Felisa Shirley On 12/16/2024 at 09:35 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 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: 12/16/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/30/2024
Section Cited
CCR
87468.2(a)

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87468.2 Additional Personal Rights of Residents in Privately Operated Facilities

(a) In addition to the rights listed in Section 87468.1, Personal Rights of Residents in All Facilities, residents in privately operated residential care facilities for the elderly shall have all of the following personal rights…

This requirement was not met as evidenced by:

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The Adminstrator shall implement a system designed to answer pull cord alerts faster. Administrator will delegate the pull cord alerts over to the Med Techs which she feels will get a faster response in getting those alerts over to the caregivers to be of assistance to residents in care. Please send copies of Plan of Corrections to LPA Felisa Shirley by email at felisa.shirley@dss.ca.gov or by fax to (424)544-1016 by POC date of 12/30/24.

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Based on interviews and records review, facility staff did not assist R-1 after being alerted in a timely manner which poses a possible health and safety risk to persons 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.
SUPERVISOR'S NAME:Stephanie Cifuentes
LICENSING EVALUATOR NAME:Felisa Shirley
LICENSING EVALUATOR SIGNATURE:
DATE: 12/16/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/16/2024


LIC809 (FAS) - (06/04)
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