198602567-10-31-2025-11-AS-SCIS-DU4VPL-20260515163653

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198602567
Report Date: 10/31/2025
Date Signed: 10/31/2025 05:30:55 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
10/24/2025 and conducted by Evaluator Bernadette Allen

COMPLAINT CONTROL NUMBER: 11-AS-20251024151343

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:	10/31/2025
		ANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Robert Jakini-Administrator		TIME COMPLETED:	03:45 PM

ALLEGATION(S):

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Staff do not ensure that resident has a sanitary drinking dish

INVESTIGATION FINDINGS:

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On 10/30/2025, Licensing Program Analyst (LPA) Bernadette Allen conducted an unannounced visit to initiate and deliver findings for the alleged allegation. LPA identified herself and met Robert Jakini Administrator who was informed of the purpose of the visit.

The investigation consisted of the following

LPA obtained residence and staff roster, LPA also reviewed R1’s service plan and Physicians orders for 2024 and 2025, LPA conducted Interviews with Staff Members 1-7 (S1-S7), Residents 1-7 (R1-R7), One (1) external witnesses1 (W1) and attempted to interview Resident 1 (R1).

Continued...

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Bernadette Allen
LICENSING EVALUATOR SIGNATURE:	DATE: 10/31/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/31/2025

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 3

Control Number 11-AS-20251024151343

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: 10/31/2025

NARRATIVE

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The investigation revealed the following

At 9:35 AM, LPA attempted to interview R1, who was not willing to engage in a conversation.
LPA observed R1 with a purple thermos. R1’s personal companion opened the thermos, which was filled with water, and no mold was observed.

At 9:45AM, LPA conducted interviews with staff members (S1–S7) and 7 out of 7 staff members stated that staff ensure residents’ cups are cleaned and sanitized daily throughout the day. Staff reported that residents typically receive water in their personal bottles or cups. Juices are served in facility- provided clear cups, which are cleaned after each use.

When asked if mold had ever been seen in any residents’ personal cups, 7 out of 7 staff members stated they had not observed mold in any cups.

When asked if residents are allowed to drink from their own personal cups, 7 out of 7 staff members stated yes, and that personal cups are also cleaned and sanitized daily.

LPA Allen interviewed Witness (W1), who stated they heard about R1’s personal cup having mold but did not personally observe any mold during the week of 10/20/2025 through 10/24/2025. W1 stated R1 normally drinks orange-colored Pedialyte in their personal cup. When asked if staff clean and sanitize the cup, W1 responded yes.

LPA also interviewed residents R1–R7 and 7 out 7 residents stated they have not had mold in their personal cups or in cups provided by staff. When asked if staff clean their personal cups, 7 out of 7 residents stated yes.

Continued

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Bernadette Allen
LICENSING EVALUATOR SIGNATURE:	DATE: 10/31/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/31/2025

LIC9099 (FAS) - (06/04)

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Control Number 11-AS-20251024151343

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: 10/31/2025

NARRATIVE

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Although the allegation suggests that staff do not ensure residents have sanitary drinking dishes, evidence gathered through observations, interviews with staff and residents, and a review of documentation did not support this claim. Therefore, based on interviews conducted, documents reviewed, and observations made, the above allegation is found to be Unsubstantiated meaning that 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.

An exit interview was conducted where this report was discussed and provided to Robert Jakini-Administrator, at conclusion of the visit with appeal rights. Robert Jakini authorized xxxx to sign the report

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Bernadette Allen
LICENSING EVALUATOR SIGNATURE:	DATE: 10/31/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/31/2025

LIC9099 (FAS) - (06/04)

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