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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198602620
Report Date: 10/12/2023
Date Signed: 10/12/2023 02:26:58 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/19/2023 and conducted by Evaluator Alfonso Iniguez
COMPLAINT CONTROL NUMBER: 11-AS-20230919145601
FACILITY NAME:LONG BEACH RESIDENTIALFACILITY NUMBER:
198602620
ADMINISTRATOR:CRYSTAL BARRIENTOSFACILITY TYPE:
735
ADDRESS:4201 EAST 10TH STREETTELEPHONE:
(562) 433-2455
CITY:LONG BEACHSTATE: CAZIP CODE:
90804
CAPACITY:49CENSUS: 41DATE:
10/12/2023
UNANNOUNCEDTIME BEGAN:
02:09 PM
MET WITH:Anthony Griffin-Assistant Administrator.TIME COMPLETED:
02:26 PM
ALLEGATION(S):
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Allegation: Staff mismanaged resident's medication
INVESTIGATION FINDINGS:
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On 10/12/2023 LPA Alfonso Iniguez conducted an unannounced complaint visit. LPA Iniguez meet with Anthony Griffin / Assistant Administrator. LPA explained the purpose of this visit.

Investigation Consisted of: LPA conducted interviews with: Assistant Administrator (A#1), Staff (S#1-S#4), residents (R#1-R#7) and witnesses (W#1 and W#2). LPA obtained and reviewed the following documents: Client’s roster, Personnel roster, (R#1-R#4) Identification and Emergency Information, (R#1-R#4) Physicians Report for Residential Care Facilities for the Elderly, (R#1-R#4) Needs and Services Plan, (R#1-R#4) Medication Administration Record (MAR) from April-September 2023, (R#1) hospitalization records from 9/1/2023, (A#1, S#1, S#2,and S#3) ARF Medication Training Program Certificate of Completion done on 12/8/2019, photos of medications that came by mail and a facility physical tour.

Evaluation Report continues LIC 9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Alfonso Iniguez
LICENSING EVALUATOR SIGNATURE:

DATE: 10/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/12/2023
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 4
Control Number 11-AS-20230919145601
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME: LONG BEACH RESIDENTIAL
FACILITY NUMBER: 198602620
VISIT DATE: 10/12/2023
NARRATIVE
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Investigation Revealed the Following:

Allegation: Staff mismanaged resident's medication

The details of the complaint alleged that the facility staff are mismanaging client’s medications.



During the records review, LPA Iniguez observed the following: (R#1) discharge hospital summary records from 9/1/2023. The records indicated (R#1) was hospitalized due to pelvic pain; the documents did not show (R#1) was hospitalized due to a medication overdose. In addition, LPA took a picture of a medication bottle during the visit on 9/26/2023. According to (A#1), this medication bottle was mailed to (R#1) without a prescription, and it is the same medication that was prescribed to (R#1) by her physician. Also, LPA acquired copies of (A#1, S#1, S#2, and S#3) the ARF Medication Training Program Certificate of Completion done on 12/8/2019. Moreover, LPA reviewed the Medication Administration Records (MAR) from (R#1), and no discrepancies were found. On 10/10/2023 (A#1) told LPA that the facility just received another package by mail containing a medication that (R#1) is getting as prescribed medication at the facility. LPA asked (A#1) if the package said who sent the medication, he said no, it only shows the website where it was purchased. LPA asked (A#1) to send him a picture of the package and the medication bottle.

During an Interview with the Administrator (A#1), he stated that all residents/clients are getting their medications as prescribed by their physician, and the system that the facility uses to distribute medications in bubble packs. Then, we put the medications in containers labeled with the days of the week to distribute the medications. Also, (A#1) stated that the staff who oversees passing medications understands how to follow and read the physician’s prescription. In addition, (A#1) stated that (R#1) gets prescribed medications by mail. (A#1) stated that (R#1) calls her family, and they send her the prescriptions by mail. (A#1) receives the packages at the front office. Moreover, (A#1) stated that no other resident/client has ever had their medication mismanaged by the staff, and the staff can communicate clearly with residents/clients without problem.

Evaluation Report continues LIC 9099-C

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Alfonso Iniguez
LICENSING EVALUATOR SIGNATURE:

DATE: 10/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/12/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 11-AS-20230919145601
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME: LONG BEACH RESIDENTIAL
FACILITY NUMBER: 198602620
VISIT DATE: 10/12/2023
NARRATIVE
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During interviews with residents (R#1-R#4), 6 out of 7 stated that they had not gotten their prescribed medication twice the same day, and they have yet to hear if another resident did not get their medication as prescribed. In addition, 7 out of 7 stated that they have not heard if another resident got their medication wrong because the staff did not follow the doctor’s order, and they can understand the staff.

During interviews with staff (S#1-S#4), 4 out of 4 stated that the residents/clients are getting their medications as prescribed by their physician, and the facility has a system in place for distributing medications to them. Also, 4 out of 4 staff stated that they understand how to follow the doctors’ orders in the residents/clients’ prescriptions, and they did not know if a resident/client has ever gotten an incorrect medication dose and they did not know if a resident/client went to the hospital due to an overdose of a mismanaged medication by the facility. In addition, 4 out of 4 staff stated that they can communicate clearly with the residents/clients, and the residents/clients can understand them.

During an interview with witness #1 (W#1), she stated that she only sent over-the-counter medications to (R#1) by mail because she thought her insurance did not cover these medications. LPA asked (W#1) if she ever sent prescription medications to (R#1). W #1 stated that she has never sent prescription medications by mail to (R#1). However, (W#1) mentioned that (R#1) gets very upset when “things” don’t get her way.

Evaluation Report continues LIC 9099-C

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Alfonso Iniguez
LICENSING EVALUATOR SIGNATURE:

DATE: 10/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/12/2023
LIC9099 (FAS) - (06/04)
Page: 4 of 4
Control Number 11-AS-20230919145601
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754
FACILITY NAME: LONG BEACH RESIDENTIAL
FACILITY NUMBER: 198602620
VISIT DATE: 10/12/2023
NARRATIVE
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During the interview with witness #2 (W#2), she stated that when she sees (R#1), she said the prescription dosage is not working. (W#2) stated that she had changed the current dose and sent it to the pharmacy to update the order. (W#2) stated that (R#1) also told her that the facility was not giving her their medications; LPA asked (W#2) how she would know the facility was giving (R#1) her medications. (W#2) stated that she looked at (R#1’s) Medication administration record (MAR), and there are no discrepancies on her medication.

During this investigation, LPA found did not find sufficient evident to support the above-mentioned allegations.

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

Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is unsubstantiated.


California Code of Regulations (Title 22, Division 6, Chapter 8).

An exit interview was conducted, and a copy of the Complaint Report was given to Anthony Griffin/Assistant Administrator.

SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Alfonso Iniguez
LICENSING EVALUATOR SIGNATURE:

DATE: 10/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/12/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 4