198602567-1-30-2026-11-AS-UCOL-DSJTRE-20260326145722

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198602567
Report Date: 01/30/2026
Date Signed: 01/30/2026 12:22:50 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
01/28/2026 and conducted by Evaluator Regina Cloyd

COMPLAINT CONTROL NUMBER: 11-AS-20260128122053

FACILITY NAME:	REGENCY PALMS LONG BEACH		FACILITY NUMBER:	198602567
ADMINISTRATOR:	ROBERT JAKINI		FACILITY TYPE:	740
ADDRESS:	117 E 8TH STREET		TELEPHONE:	(562) 432-9260
CITY:	LONG BEACH	STATE: CA	ZIP CODE:	90813
CAPACITY:	91	CENSUS: 74	DATE:	01/30/2026
		UNANNOUNCED	TIME BEGAN:	08:28 AM
MET WITH:	Alyssa Rios		TIME COMPLETED:	12:30 PM

ALLEGATION(S):

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Staff are not releasing resident's records to their responsible party as required.

INVESTIGATION FINDINGS:

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On 01/30/2026, Licensing Program Analyst (LPA) Regina Cloyd conducted an initial visit to gather information regarding the above allegation. LPA met with Alyssa Rios and the purpose of the visit was explained. LPA spoke with Executive Director Robert Jakini over the phone.

Investigation consisted of the following: On 01/30/2026, LPA obtained Personnel Report, Register of Residents, Resident #1’s (R1) Resident Lease Agreement, Telecommunications Device Notification, Release of Resident Medical Information, Consent for Emergency Medical Treatment, Personal Rights, Facility Assessment Determination Addendum, and Uniform Statutory Form Power of Attorney. LPA interviewed Staff #1 - #4, Witness #1, and Residents #5 - #9. LPA attempted to interview R1 – R4 and Witnesses #2 - #5.

Continue to LIC9099-C.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Regina Cloyd
LICENSING EVALUATOR SIGNATURE:	DATE: 01/30/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/30/2026

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 11-AS-20260128122053

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: 01/30/2026

NARRATIVE

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Investigation revealed the following:

Regarding the allegation, “Staff are not releasing resident's records to their responsible party as required, it is being alleged that the staff did not release Resident #1’s (R1) records to a third party with verbal consent from the Power of Attorney (POA). Record review of Uniform Statutory Form Power of Attorney (04/20/2023) revealed Witness #1 (W1) has all financial powers for R1. Review of R1’ Facility Assessment Determination Addendum (02/20/2024) revealed the facility services, PACE covered services, and daily reimbursement. Review of Release of Resident Medical Information (02/13/2024) revealed R1’s Primary Care Physician is authorized to release R1’s medical or confidential information to the facility. LPA did not observe release of resident medical information to the third party. Interview with the Executive Director (S1) indicated staff cannot release records without the family’s permission. Interview with Staff #3 indicated a release form is required for records and the facility will also speak with their consultants and counsel for advice. Interview with W1 indicated W1 did not provide written consent to the third party nor to the facility. Four out of five resident interviews (R5 – R9) were unable to confirm if the facility would release their medical records to self, family, or third parties.

Regarding the allegation, “Staff are not releasing resident's records to their responsible party as required,” 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.

An exit interview was conducted and a copy of this report with was reviewed the Executive Director and left with Staff Alyssa Rios.

SUPERVISORS NAME: Ulysses Coronel
LICENSING EVALUATOR NAME: Regina Cloyd
LICENSING EVALUATOR SIGNATURE:	DATE: 01/30/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/30/2026

LIC9099 (FAS) - (06/04)

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