198602567-4-22-2026-11-AS-JHAD-DTSSM5-20260505135922

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198602567
Report Date: 04/22/2026
Date Signed: 04/22/2026 02:27:19 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
04/06/2026 and conducted by Evaluator Zina Brown

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20260406104835

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: 68	DATE:	04/22/2026
		UNANNOUNCED	TIME BEGAN:	08:45 AM
MET WITH:	Robert Jakini (Administrator)		TIME COMPLETED:	01:00 PM

ALLEGATION(S):

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Staff do not properly store residents medications.
Staff do not keep an accurate medication record.
Staff do not allow residents to make healthcare decisions.
Staff do not provide residents access to personal property/belongings.
Staff retaliate against resident.

INVESTIGATION FINDINGS:

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On 04/22/2026 at 8:30am, the department conducted an subsequent visit at the facility listed above to facility to deliver the complaint findings for the allegations above. During today’s visit, the department met with Robert Jakini (Administrator) and explained the purpose of the visit.

The investigation consisted of the following: On 04/13/2026, the Department conducted interview between the hours of 9:38am - 2:50pm with the Administrator (A1), Staff (S1 - S7) & Resident (R1 - R7) between the hours of 9:36am - 3:30pm. Also the Department requested the following documentation Staff Roster (received 04/13/2026), Resident Roster (received 04/13/2026), LIC 601 Identification and Emergency Information (dated 10/22/2024), LIC 602A Physician’s Report (dated 7/15/2025), LIC 603 Pre-Admission Appraisal (dated10/21/2025), LIC 621 Personal Property Inventory (dated 10/21/2024), LIC 613 Personal Rights (dated 10/21/2024) LIC 625 Appraisal/Assessment, Medication Administration Records (MARs) January 1, 2026 – April 13, 2026, Resident Assessment (dated 10/23/2024 & 12/31/2025) and Admission Agreement (dated 10/22/2024).

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Zina Brown
LICENSING EVALUATOR SIGNATURE:	DATE: 04/22/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/22/2026

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-20260406104835

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: 04/22/2026

NARRATIVE

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The investigation revealed the following:

Allegation 1: Staff do not properly store residents’ medications.
It was alleged that facility staff restricted a resident access to their over the counter (OTC) supplements and health related items.

On 04/13/2026 at 1:01pm, the Department interviewed A1 regarding the allegation. A1 denied the allegation, and stated that all over the counter (OTC) supplements are treated as medications, must be profiled into the medication administration record (MAR), and are stored either in a locked cabinet for residents cleared to self administer or in the medication room/medication cart for residents who cannot self administer.

On 04/13/2026 between 9:38am - 12:19pm, the department interviewed seven (7) staff regarding the allegation. 7 out of 7 staff denied the allegation.

On 04/13/2026 between the hours of 10:47am - 11:46am, the Department interviewed seven (7) residents. 2 out of 7 residents confirmed the allegation. Of the two (2) residents who confirmed the allegation ; R1 mentioned sometimes staff has taken and or held their over the counter (OTC) supplements without permission due to supplement being kept in resident room on top of their dresser. 5 out of 7 residents denied the allegation and stated have staff have not handle, stored or restricted residents medication and or over the counter supplements without knowledge their and or permission.

On 04/13/2026 between the hours of 11:20am - 11:40am, the Department conducted an observation and record review and observed the following: Based on Clarity healthcare - Resident Assessment Form (completed 10/23/2024) in the medication section with a checkmark for requires routine medication management with one (1) to four (4) medications at routine times (up to 5x per day). With service provider responsibilities: MedTech will manage residents medication and will also coordinator with doctor for all new and current medication orders. Also on R1's Resident Assessment (dated 12/31/2025) under the medication management section it states minimal - central storage and set up of medication (4).

Report continues on LIC 9099-C

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Zina Brown
LICENSING EVALUATOR SIGNATURE:	DATE: 04/22/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/22/2026

LIC9099 (FAS) - (06/04)

Page: 2 of 7

Control Number 11-AS-20260406104835

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: 04/22/2026

NARRATIVE

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Now in the facility agreement it states the following: Please do not bring any medication that are not on the medication list. R1's has a CareMore Health Rx (dated 04/08/2026) which states it's okay for R1 to keep all over the counter medication in their room to self administer. Yet in the admission agreement ; under the house rules it states: 2. All medication must be stored in a centrally stored area. Physician must approve mediation. This also includes but not limited to: prescription medication, over the counter medications, ointments and vitamins. 3. All medication shall be stored in its originally received container along with current physicians order. Medications that are not on the physician order will not be accepted. 4. All medications being stored in apartment (providing physician gives written approval) must be stored in a locked container. Also on 04/13/2026 between the hours of 11:20am - 11:25am, the Department witnessed the facility providing R1 with a clear lock box combination to store over-the-counter (OTC) supplements which R1 refused multiple time to keep the lock box combination in the room.

Based on records review, interviews, and observations, the Department did not find sufficient 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 do not keep an accurate medication record.
It was alleged that staff failed to maintain accurate medication documentation for the resident.

On 04/13/2026 at 1:01pm, the Department interviewed A1 regarding the allegation. A1 denied the allegation, stated that all medications, supplements, and OTC items must be profiled and logged in the facility’s electronic MAR system (QuickMAR), and that the system requires documentation of each administered or missed dose.

On 04/13/2026 between 9:38am - 12:19pm, the department interviewed seven (7) staff regarding the allegation. 7 out of 7 staff denied the allegation. Of the seven (7) staff ; two (2) of the staff are Medtech and mentioned centrally stored mention is documented even if the resident does not get the medication through the pharmacy. The Medtech will send in the medication order for the pharmacy to profile on the Quickmar.

Report continues on LIC 9099-C

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Zina Brown
LICENSING EVALUATOR SIGNATURE:	DATE: 04/22/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/22/2026

LIC9099 (FAS) - (06/04)

Page: 3 of 7

Control Number 11-AS-20260406104835

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: 04/22/2026

NARRATIVE

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On 04/13/2026 between the hours of 10:47am - 11:46am, the Department interviewed seven (7) residents regarding the allegation. 1 of 7 resident confirmed the allegation and stated staff do not tell the resident when they handle or document anything related to your medications or health items. 2 of 7 residents were unsure of documentation practices. 4 of 7 residents denied the allegation and reported no issues.

On 04/22/2026, between the hours of 9:05am - 10:30am, the department conducted a records review for 7 of the residents medication administrator record (MAR) (dated April 2026) and observed the following: According to MAR for Resident 2 (R2) - Resident 7 (R7) their medications were administered as prescribed from 04/01/2026 - 04/22/2026. For R1 medications such as Amlodipine Besylate 5 Mg Tab was administered from 04/01/2026 - 04/22/2026. As for Atorvastatin 20 mg tablet, R1 refused from 04/01/2026 - 04/22/2026 and Moxifloxacin 0.5 Eye Drops which is not given by the facility at 8am nor 5pm due to MAR stating ok to keep at bedside and self-administer. As for R1's PRN's it consist of Naproxen 250mg tablet, Refresh Tears 0.5% Eye Drop, Systane Ultra 0.4 - 0.3% Eye Drop.

Based on records review, interviews, and observations, the Department did not find sufficient evidence of missing nor inaccurate entries of medication 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 do not allow residents to make healthcare decisions.
It was alleged that staff restricted residents from accessing or using their own OTC health items.

On 04/13/2026 at 1:01pm, the Department interviewed A1 regarding the allegation. A1 denied the allegation, and stated that residents may make healthcare decisions only to the extent permitted by their LIC 602, and that OTC items are treated as medications under Title 22. Residents who are not cleared to self administer cannot independently access OTC items due to safety and risk.

On 04/13/2026 between 9:38am - 12:19pm, the department interviewed seven (7) staff regarding the allegation. 7 of 7 staff denied the allegation.

Report continues on LIC 9099-C

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Zina Brown
LICENSING EVALUATOR SIGNATURE:	DATE: 04/22/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/22/2026

LIC9099 (FAS) - (06/04)

Page: 4 of 7

Control Number 11-AS-20260406104835

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: 04/22/2026

NARRATIVE

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On 04/13/2026 between the hours of 10:47am - 11:46am, the Department interviewed seven (7) residents regarding the allegation. 2 out of 7 residents confirmed the allegation and reported they were prevented from making certain healthcare decisions. 5 out of 7 residents denied the allegation and expressed being able to make their own decision about their healthcare decisions.

On 04/17/2026 between the hours of 4:20pm - 4:25pm, the Department conducted a record review and did not observe any documentation indicating improper restriction beyond the limitations outlined in residents’ LIC 602 Physician's Report for Residential Care Facilities for the Elderly (RCFE) (dated 10/09/2024) which is mentioned on page 4 of 6 under 16. Medication Management a. Able to Administer Own Prescription Medications - its checked no and b. Able to Store Own its check no. Also R1's Resident Assessment (dated 12/31/2025) under coordinator with outside agencies it states minimal - reminders for healthcare and home care appointments (0) with details such as support coordination transportation to appointments and telemedicine coordination.

Based on records review, interviews, and observations, the Department did not find sufficient 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 do not provide residents access to personal property/belongings.
It was alleged that staff withheld or delayed residents’ packages or personal items.

On 04/13/2026 at 1:01pm, the Department interviewed A1 regarding the allegation. A1 denied the allegation, stated that all packages are received at the front desk and are either picked up by residents or delivered by staff. A1 reported no knowledge of any packages being withheld and stated that the resident was informed that certain items could not be kept in R1's room.

On 04/13/2026 between 9:38am - 12:19pm, the department interviewed seven (7) staff regarding the allegation. 7 out of 7 staff denied the allegation.

Report continues on LIC 9099-C

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Zina Brown
LICENSING EVALUATOR SIGNATURE:	DATE: 04/22/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/22/2026

LIC9099 (FAS) - (06/04)

Page: 5 of 7

Control Number 11-AS-20260406104835

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: 04/22/2026

NARRATIVE

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On 04/13/2026 between the hours of 10:47am - 11:46am, the Department interviewed seven (7) residents regarding the allegation. 2 out of 7 residents confirmed the allegation. Of the two (2) residents who confirmed the allegation ; R1 reported delays and or issues receiving belongings. 5 of 7 residents denied the allegation and reported no issues with access to their personal property/belongings.

On 04/17/2026 between the hours of 4:20pm - 4:25pm, the Department conducted a record review and observed the following: in the admission agreement ; under the Miscellaneous section: 2. packages delivered to the Community for the Resident will be delivered to the Resident's apartment by one of the staff members. Upon observation there is not any documentation to support the allegation.

Based on records review, interviews, and observations, the Department did not find sufficient 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 retaliate against residents.
It was alleged that staff treated residents differently after they made complaints.

On 04/13/2026 at 1:01pm, the Department interviewed A1 regarding the allegation. A1 denied the allegation, stated that although the resident has expressed frustration and displayed aggressive behaviors toward staff, there has been no change in staff conduct toward him. A1 reported that the facility may request reassessment due to behavioral concerns.

On 04/13/2026 between 9:38am - 12:19pm, the department interviewed seven (7) staff regarding the allegation. 7 out of 7 staff denied the allegation.

On 04/13/2026 between the hours of 10:47am - 11:46am, the Department interviewed seven (7) residents regarding the allegation. 2 out of 7 residents confirmed the allegation and reported experiencing or witnessing differential treatment after making an complaint. 1 out of 7 residents was unsure of the allegation. 4 of 7 residents denied the allegation.

Report continues on LIC 9099-C

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Zina Brown
LICENSING EVALUATOR SIGNATURE:	DATE: 04/22/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/22/2026

LIC9099 (FAS) - (06/04)

Page: 6 of 7

Control Number 11-AS-20260406104835

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: 04/22/2026

NARRATIVE

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On 04/17/2026 between the hours of 4:20pm - 4:25pm, the Department reviewed records and did not observe any documentation to support retaliatory conduct.

Based on records review, interviews, and observations, the Department did not find sufficient 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.

Exit interview conducted with Robert Jakini (Administrator) and a copy of this report was provided.

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Zina Brown
LICENSING EVALUATOR SIGNATURE:	DATE: 04/22/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/22/2026

LIC9099 (FAS) - (06/04)

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