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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198602567
Report Date: 08/06/2026
Date Signed: 08/06/2026 10:52:45 AM

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
12/17/2025 and conducted by Evaluator Zina Brown
PUBLIC
COMPLAINT CONTROL NUMBER: 11-AS-20251217122530
FACILITY NAME:REGENCY PALMS LONG BEACHFACILITY NUMBER:
198602567
ADMINISTRATOR:ROBERT JAKINIFACILITY TYPE:
740
ADDRESS:117 E 8TH STREETTELEPHONE:
(562) 432-9260
CITY:LONG BEACHSTATE: CAZIP CODE:
90813
CAPACITY:91CENSUS: 69DATE:
08/06/2026
UNANNOUNCEDTIME BEGAN:
08:40 AM
MET WITH:Robert Jakini (Adminstrator)TIME COMPLETED:
11:00 AM
ALLEGATION(S):
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Staff did not ensure a fall plan was put in place after resident had prior falls resulting in a brain bleed
INVESTIGATION FINDINGS:
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On 08/06/2026 at 8:40am, Licensing Program Analyst (LPA) Zina Brown conducted a subsequent visit to deliver the investigation findings. LPA met with Robert Jakini (Administrator) and the purpose of the visit was explained.

The investigation consisted of the following: On 12/18/2025, the Department obtained copies of the following: LIC 500 Personnel Report (dated 12/08/2025), Resident Roster (received on 12/18/2025), Staff Schedule for 12/15/2025 - 12/20/2025, List of Fall Risk Residents (received on 12/18/2025), Resident 1(R1) documentation such as LIC 601 Emergency Identification (date 05/09/2024), LIC 602 Physician Report (dated 08/07/2025 & 04/18/2024), LIC 603 Pre-Placement Appraisal (dated 05/11/2024), Admission Agreement (dated 05/08/2024), Service Plan (dated 07/29/2025,12/03/2025 & 12/27/2025), Physician's Orders (printed 12/18/2025), Resident Assessment (dated 04/29/2025 & 01/06/2026), Progress Notes (dated 07/24/2024 - 12/16/2025), Admission Orders (dated 05/04/2024) and SIRS (03/07/2025, 04/13/2025, 08/02/2025, & 08/17/2025. . .investigation findings continue on LIC 9099-C.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Zina Brown
LICENSING EVALUATOR SIGNATURE:

DATE: 08/06/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/06/2026
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 5
Control Number 11-AS-20251217122530
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: 08/06/2026
NARRATIVE
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On 03/04/2026 at 2:19pm, the Department interviewed W1. W1 stated R1 sustained may falls and the facility did not notify W1 about the first fall and learned about it from the hospital instead.

On 04/29/2026 at 4:32pm, the Department interviewed W2. W2 stated R1 is ambulatory and is a fall risk that needed a better line of sight to prevent falls.

The records review showed that R1 was admitted to the facility in May 2024 with documentation indicating that R1 was ambulatory and able to complete personal care tasks independently. The physician’s report (dated 04/18/2024), and the admission orders (dated 05/04/2024), reflected that R1 did not require assistance with bathing, dressing, grooming, toileting, or mobility at the time of admission. The pre-placement appraisal (dated 05/11/2024), noted mild mobility impairment, moderate forgetfulness, confusion, and occasional need for night supervision due to wandering. These early records established R1’s baseline functioning and cognitive limitations.

In March, April, and August 2025, R1 was involved in resident-to-resident altercations resulting in minor injuries. On 07/22/2025, staff documented that R1 experienced dizziness in the morning. On 10/30/ 2025, R1 sustained an unwitnessed fall resulting in a hematoma above the right eye and was transported to the hospital. On 11/08/2025, R1 sustained another unwitnessed fall, reporting that R1 fell from the bed and hit the back of the head, resulting in another hematoma and hospital transport. Hospital records from 11/08/2025 - 11/12/2025, documented intracranial bleeding and a left cerebral convexity acute subdural hemorrhage. These incidents demonstrated a pattern of unwitnessed falls and repeated head injuries.

In December 2025, records showed a series of health-related entries and additional falls. R1 returned from Alamitos Belmont Rehabilitation, a skilled nursing facility on 12/03/2025. On 12/04/2025 R1 complained of stomach pain, and on 12/11/2025, R1 complained of right leg pain. On December 14, 2025, R1 sustained an unwitnessed fall at 0515 hours and was assisted back to bed. On 12/15/2025, R1 sustained another unwitnessed fall and was found on the bathroom floor complaining of head pain. Hospital records from St. Mary Medical Center (dated 12/15/2025 - 12/16/2025) documented a large mixed-density subdural hematoma with midline shift. On 12/16/2025, ICU staff notified the facility that the incident would be reported due to R1’s history of repeated hospitalizations for unwitnessed falls. R1 remained hospitalized through 12/22/2025, 2025, with records noting frequent falls and a decision to forego neurosurgical intervention. A final December entry dated 12/27/2025, indicated no complaints.

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Zina Brown
LICENSING EVALUATOR SIGNATURE:

DATE: 08/06/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/06/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 11-AS-20251217122530
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: 08/06/2026
NARRATIVE
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A resident assessment (dated 01/06/2026), documented that R1 required assistance with bathing, dressing, grooming, hygiene, and toileting, and required observation and fall management, including safety checks four times per shift. This assessment reflected a significant change from R1’s earlier functioning. Additional records obtained in January 2026 - February 2026 included medical records from the hospital and attempts to interview staff. Interviews conducted in March 2026 with S2 and S1 confirmed that R1 sustained unwitnessed falls, complained of head pain, and that R1’s family resisted hospital transport. On 03/18/2026, resident interviews were conducted, and R1 declined to participate. On 04/29/2026, W2 stated that R1 was a fall risk and required improved visibility and supervision to prevent falls.

Based on the evidence gathered, interviews conducted, and records reviewed, the preponderance of evidence standard has been met; therefore, the above-mentioned allegation are found to be SUBSTANTIATED.

California Code of Regulations (Title 22, Division 6, Chapter 8), the above-mentioned deficiencies were observed, and citation issued (ref. LIC 9099D).

*Immediate Civil Penalty issued*

ECP: At this time, an enhanced civil penalty determination is pending in reference to Health & Safety Code

1569.49(f) For a violation that the department determines constitutes physical abuse, as defined in Section

15610.63 of the Welfare and Institutions Code, or resulted in serious bodily injury, as defined in Section

15610.67 of the Welfare and Institutions Code, to a resident, the civil penalty shall be ten thousand dollars ($10,000).

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

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Zina Brown
LICENSING EVALUATOR SIGNATURE:

DATE: 08/06/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/06/2026
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 11-AS-20251217122530
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: 08/06/2026
NARRATIVE
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& St. Mary Medical Center Record (dated 11/08/2025 - 11/12/2025, 12/15/2025 -12/22/2025). The Department conducted interviews with the Administrator (A1) on 01/21/2026 at 9:06am. on 02/26/2026 at 4:34pm with Staff 1 (S1), on 03/11/2026 with Staff 1 (S1) & Staff 2 (S2) between the hours of 10:13am - 10:23am , on 03/18/2026 between the hours of 1:30pm - 1:34pm with Resident 2 (R2) and Resident 3 (R3), on 03/04/2026 at 2:19pm with Witness 1 (W1) and on 04/29/2026 at 4:32pm with Witness 2 (W2)

The investigation revealed the following:

Allegation: Staff did not ensure a fall plan was put in place after resident had prior falls resulting in a brain bleed
It was alleged that staff failed to ensure an appropriate fall-prevention plan for Resident 1 (R1), who had a history of multiple unwitnessed falls, resulting in the resident sustaining another unwitnessed fall on 12/15/2025 that caused an intracranial hemorrhage.

On 01/21/2026 at 09:08am, the Department interviewed Administrator (A1) in regard to the allegation. A1 denied the allegation stated R1 was not a fall risk. A1 mentioned the fall that had occurred on 12/14/2025 and R1 did not sustain any visible cuts or injuries. A1 also stated that on 12/15/2025, R1 fell and hit their head. At the time of interview on 01/21/2026 at 9;08, A1 admitted the fall that occurred on 12/14/2025 was not reported to the Department of Social Services Community Care Licensing Division (CDSS CCL). A1 stated round checks had no set schedule

On 02/26/2026 at 4:34pm and on 03/11/2026 between the hours of 10:13pm - 10:23am, the Department interviewed S1 and S2 regarding the allegation. 2 out of 2 staff confirmed the allegation. During the interview on 02/26/2026, S1 discovered R1 on the bathroom floor. When S1 asked R1 if they were okay R1 said no and pointed to their head. S1 verified R1's unwitnessed fall and the R1's family resisted hospital transfer. On 03/11/2026 at 10:23am, S1 further stated hearing a loud sound to discover R1 on the bathroom floor and touching their head indicating pain. On 03/11/2026 at 10:13am, S2 stated R1 sustained unwitnessed falls and required increase care due to being a fall risk.

On 03/18/2026 between the hours of 1:30pm - 1:34pm, the Department conducted interviews with 2 residents in regards to the allegation. R1 refused to be interviewed. 2 out 2 residents did not confirm nor deny the allegation. R2 and R3 stated having no concerns, no issues nor complaints related to the allegation and no information was provided.

Investigation findings continue on LIC 9099-C

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Zina Brown
LICENSING EVALUATOR SIGNATURE:

DATE: 08/06/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/06/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 11-AS-20251217122530
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: 08/06/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/07/2026
Section Cited
CCR
87463(b)(1)
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Reappraisal shall document significant physical, mental, cognitive, behavioral, or functional changes in resident condition per Sec. 87466 Observation of Resident (1) Significant changes in condition, as defined in Section 87101, Definitions, include, but are not limited
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The facility will conduct an in service training for all staff on 87463 Reappraisal and 87466 Observation of the Resident. The facility will submit proof of training to the department by POC due date via email to LPA Brown at Zina.Brown@dss.ca.gov
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This requirement was not met as evidenced by: based on interviews and record review, facility failed to reassess R1 upon change in condition (fall risk), resulting in multiple unwitnessed falls, including a 12/15/25 fall causing an intracranial hemorrhage.
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An immediate $500 civil penalty assessed.
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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: Janae Hammond
LICENSING EVALUATOR NAME: Zina Brown
LICENSING EVALUATOR SIGNATURE:

DATE: 08/06/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/06/2026
LIC9099 (FAS) - (06/04)
Page: 5 of 5