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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198602567
Report Date: 05/20/2025
Date Signed: 05/20/2025 03:59:00 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
02/01/2023 and conducted by Evaluator Sparkle Day
COMPLAINT CONTROL NUMBER: 11-AS-20230201113427
FACILITY NAME:REGENCY PALMS LONG BEACHFACILITY NUMBER:
198602567
ADMINISTRATOR:CARLA MARIANOFACILITY TYPE:
740
ADDRESS:117 E 8TH STREETTELEPHONE:
(562) 432-9260
CITY:LONG BEACHSTATE: CAZIP CODE:
90813
CAPACITY:91CENSUS: 74DATE:
05/20/2025
UNANNOUNCEDTIME BEGAN:
03:25 PM
MET WITH:Fabiola Marcia, AdministratorTIME COMPLETED:
04:30 PM
ALLEGATION(S):
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Questionable Death
Staff did not ensure postural support were used as prescribed
INVESTIGATION FINDINGS:
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On 05/20/2025 Licensing Program Analyst (LPA) Sparkle Day initiated a complaint investigation to Regency Palms Long Beach to deliver the investigation findings for the allegations listed above. LPA met with Administrator Fabiola Marciano (S1) and the purpose of the visit was explained.
The investigation consisted of the following: On 2/2/2023, the department conducted the initial visit and toured the physical plant and requested records. On 5/3/2023 and 8/30/2023, the department staff interviewed Staff #1-6 (S1-S6), Residents #2-6 (R2-R6). On 2/7/2023, 2/28/2023, 3/28/2023, 4/25/2023, 5/2/2023, the department interviewed Administrator (A1), Staff #7-8 (S7-S8) and Witness #1-2 (W1-W2). The department obtained and reviewed the following for R1: Needs and Service Plan (dated 10/01/2021, 06/09/2022, 12/09/2022), Residence Assessment Form (dated 09/04/2021), Physicians Report (dated 09/09/2021, 12/14/2022), Fall Risk Assessment (dated 09/24/2021), Incident report (dated 01/07/2023), Long Beach Fire Department incident report (dated 01/07/2023), Death Report (dated 01/07/2023), Death Certificate (dated 01/15/2023).

The Investigation revealed the following:
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Sparkle Day
LICENSING EVALUATOR SIGNATURE:

DATE: 05/20/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/20/2025
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 7
Control Number 11-AS-20230201113427
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: 05/20/2025
NARRATIVE
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Allegation: Questionable Death
The details of the complaint alleged S1 wheeled R1 into R1 bed room and left R1 unsupervised for an extended amount of time while R1 had a safety belt attached to R1 wheelchair. During this time, R1 aspirated and died. The department conducted interviews with the Administrator (A1) and Staff #1-8. A-1 Carla Mariano confirmed that R#1 was left in a room unsupervised approximately 1.5 hours with her safety belt on and was found slumped over in her wheelchair unresponsive. 8 out of 8 staff confirmed the allegation occurred.

The department conducted records review which revealed R1 was admitted to the facility on 9/4/2021 (Resident Assessment Form, dated 9/4/2021) with primary diagnoses which included hypertension, agitation, generalized muscle weakness, and dementia. R1 was dependent with all ADLs, except assistance with feeding. R1 had motor impairment/paralysis in which R1 was wheelchair bound and unable to maneuver without assistance. R1 required assistance with transfer to and from the bed. R1 was noted with fair physical health status (Physician’s Report, dated 12/14/2022). It was also noted resident had diagnosis of dysphagia (Physician’s Report dated 9/7/2021). Based on the department’s review of R1 record there was no documented evidence a care plan to address the use of safety belt on the wheelchair for R1. Also, there was no care plan to address when and how often resident should be monitored on the wheelchair with R1 safety belt fastened. Lastly, there was no care plan to address resident at risk for aspiration/choking due to diagnosis of dysphagia and or any interventions to prevent resident from injuries related to the use of safety belt.

The department reviewed the Death Certificate (dated 2/14/2023) which indicated the immediate cause: Possible aspiration.

Based on the interviews conducted and records reviewed S1 failed to properly supervise R1 resulting in the death of R1.

Based on records review and interviews, the preponderance of evidence standard has been met; therefore, the allegation of “Questionable Death” is found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division 6, Chapter 8 are being cited on the attached LIC 9099D.

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Sparkle Day
LICENSING EVALUATOR SIGNATURE:

DATE: 05/01/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/01/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 7
Control Number 11-AS-20230201113427
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: 05/20/2025
NARRATIVE
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Regarding the Allegation: Staff did not ensure postural support was used as prescribed.

This complaint alleged that staff did not follow doctor’s orders on use of R1 Postural Support (safety belt) which resulted in the resident sliding out of the wheelchair. The department conducted interviews with the Administrator (A1) and Staff #1-8. A1 confirmed the allegation and 8 out of 8 staff confirmed the allegation occurred..

The department received an Unusual Incident/Injury Report from Regency Palms at Long Beach (dated 1/7/2023), indicated: on 1/7/2023 at approx. 11:15 a.m., R1 was observed sliding out of her wheelchair. With no complaints of pain or discomfort. Staff monitored resident and adjust as needed in wheelchair if noted sliding. Records review indicate the following: R1 Physician’s Report (dated 09/27/2021) indicates the safety belt is to keep R1 from sliding or falling from R1's wheelchair.

Based on interviews and records reviewed staffed failed to use the postural support as prescribed which resulted in R1 sliding out of her wheelchair.

Based on records review and interviews, the preponderance of evidence standard has been met; therefore, the allegation of “Staff did not ensure postural support was used as prescribed.” is found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division 6, Chapter 8 are being cited on the attached LIC 9099D. An $500 immediate civil penalty assessed.

At this time, an enhanced civil penalty determination is pending in reference to Health & Safety Code 1569.49(e) Serious Death.

Exit interview conducted with Administrator and appeal rights provided.

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Sparkle Day
LICENSING EVALUATOR SIGNATURE:

DATE: 05/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/19/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 7
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
02/01/2023 and conducted by Evaluator Sparkle Day
COMPLAINT CONTROL NUMBER: 11-AS-20230201113427

FACILITY NAME:REGENCY PALMS LONG BEACHFACILITY NUMBER:
198602567
ADMINISTRATOR:CARLA MARIANOFACILITY TYPE:
740
ADDRESS:117 E 8TH STREETTELEPHONE:
(562) 432-9260
CITY:LONG BEACHSTATE: CAZIP CODE:
90813
CAPACITY:91CENSUS: 74DATE:
05/20/2025
UNANNOUNCEDTIME BEGAN:
03:25 PM
MET WITH:Fabiola Marciano, AdministratorTIME COMPLETED:
04:30 PM
ALLEGATION(S):
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9
Staff did not secure resident's medication
INVESTIGATION FINDINGS:
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3
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5
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On 05/20/2025 Licensing Program Analyst (LPA) Sparkle Day initiated a complaint investigation to Regency Palms Long Beach to deliver the investigation findings for the allegations listed above. LPA met with Administrator Fabiola Marciano (S1) and the purpose of the visit was explained.
The investigation consisted of the following: On 2/2/2023, the department conducted the initial visit and tour the physical plant and requested records. On 5/3/2023 and 8/30/2023, the department staff interviewed Staff #1-6 (S1-S6), Resident Residents #2-6 (R2-R6). On 2/7/2023, 2/28/2023, 3/28/2023, 4/25/2023, 5/2/2023, the department interviewed Administrator (A1), Staff #7-8 (S7-S8) and Witness #1-2 (W1-W2). The department obtained and reviewed the following for R1: Needs and Service Plan (dated 10/01/2021, 06/09/2022, 12/09/2022), Residence Assessment Form (dated 09/04/2021), Physicians Report (dated 09/09/2021, 12/14/2022), Fall Risk Assessment (dated 09/24/2021), Incident report (dated 01/07/2023), Long Beach Fire Department incident report (dated 01/07/2023), Death Report (dated 01/07/2023), Death Certificate (dated 01/15/2023).

The investigation revealed the following:
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Sparkle Day
LICENSING EVALUATOR SIGNATURE:

DATE: 05/20/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/20/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 7
Control Number 11-AS-20230201113427
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: 05/20/2025
NARRATIVE
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Regarding the Allegation: Staff did not secure resident's medication

It is alleged that the facility staff do not secure residents medication resulting in medication (Atorvastatin) being stolen in December 2022. On 8/30/23 at around 12:04pm The department interviewed Staff and residents. 5 of 5 residents denied they have not had any missing medications nor ever running out of medications. 4 of 4 Staff interviewed deny the allegation and state that medications is ordered from the pharmacy and delivered to the facility. The facility staff sign for medications and take to Medication Room where it is locked and secured. No medications has come up missing. The Department observed the medication Mars records for R1 from April 2022 to Jan 2023. Upon review of the medication record of R#1 ,The Department finds that medication was given to R#1 as prescribed by physician.

Based upon this investigation, LPA finds that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is UNSUBSTANTIATED.

Exit interview conducted with Administrator.

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Sparkle Day
LICENSING EVALUATOR SIGNATURE:

DATE: 05/20/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/20/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 7
Control Number 11-AS-20230201113427
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: 05/20/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type A
05/21/2025
Section Cited
CCR
87411(a)
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Personnel Requirements- Facility personnel shall at all times be sufficinet in numbers to meet resident needs. In facilities licensed for 16 or more, sufficient support staff shall be employed to ensure provision of personeel assisitance and care as required in Section 87608
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Licensee will provide a plan to reassess residents to determine staffing needs of the facility. Licensee will submit the plan to Licensing by POC due date. An IMMEDIATE $500.00 CIVIL PENALTY ASSESSED.
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This Requirement is not met as evidence by:
Based on interviews conducted and records review, Staff #1 failed to provide supervision of R1 while R1 was using a postural support (belt) which resulted in the R1 death.R1 was left unsupervised for over 45 minutes.This posed an immediate health& safety risk to residents in care
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Request Denied
Type B
05/28/2025
Section Cited
CCR
87608(a)(1)
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Postural Supports - Postural supports shall be limited to apliances or devices...used to achieve proper body position..but not limited to, preventing a resident from falling out of chair. This requirement is not met as evidence by:
Based on interviews conducted and records
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Licensee will ensure all employees receive training on Postural support and submit sign in sheets and training materials to LPA by POC date.
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reviewed on 1/7/23 resident was observed sliding out of wheelchair due to staff failing to use the prescribed postural support (safety belt). The postural support was ordered to prevent R1 from sliding/falling. This poses an health & 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: 05/20/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/20/2025
LIC9099 (FAS) - (06/04)
Page: 6 of 7
Control Number 11-AS-20230201113427
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: 05/20/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type B
05/28/2025
Section Cited
CCR
87466
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Observation of the resident_ The Licensee shall ensure that residents are regularly observed for changes in physical,mental ,emotional and social functioning and that appropriate assistance is provided when such observation reveals unmet needs.When changes are observed the licensee shall
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Licensee will have an training on reporting resident changing conditions to appropriate staff and responsible parties. by POC date
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 ensure the changes are documented and brought to the attention of the residents physician and Resposible party.
This requirement was not met as evidence by: Based on interviews facility staff were aware of changes in R1 physical limitation and R1 not being able to be left unsupervised. There is no document appraisal documenting these changes. This poses a health & 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: 05/20/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/20/2025
LIC9099 (FAS) - (06/04)
Page: 7 of 7