198602620-2-2-2024-11-AS-SCIS-D5HQ8B-20240522115627

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198602620
Report Date: 01/31/2024
Date Signed: 02/02/2024 07:54:12 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, 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
01/25/2024 and conducted by Evaluator Pamela Bunker

COMPLAINT CONTROL NUMBER: 11-AS-20240125103129

FACILITY NAME:	LONG BEACH RESIDENTIAL		FACILITY NUMBER:	198602620
ADMINISTRATOR:	CRYSTAL BARRIENTOS		FACILITY TYPE:	735
ADDRESS:	4201 EAST 10TH STREET		TELEPHONE:	(562) 433-2455
CITY:	LONG BEACH	STATE: CA	ZIP CODE:	90804
CAPACITY:	49	CENSUS: 48	DATE:	01/31/2024
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Marinel Amanda Luna and Anthony Griffin		TIME COMPLETED:	03:45 PM

ALLEGATION(S):

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Staff did not prevent pests in the resident's room
Staff are threatening a resident
Staff are not administering the resident's medication
Staff left residents unattended
Staff are not providing comfortable accommodations for resident

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Pamela Bunker conducted an unannounced complaint visit on Wednesday, January 31, 2024. Upon arrival at the facility. LPA Bunker called the facility via telephone and conducted a Risk Assessment. Based on the assessment, the facility is clear of COVID-19 infection. LPA Bunker met with Administrator Marinel Amanda Luna and Assistant Administrator Anthony Griffin. LPA Bunker explained the purpose of today's visit.
The investigation consisted of the following: Interviews were conducted with staff 1-2 (S1-S2), and residents 1-5 (R1-R5). S1-S2 and R1-R5 stated the facility had bed bugs. We toured the facility, and during today's visit, we did not observe any bedbugs. R1-R5 stated they had no roaches or bedbugs in their rooms. S1-S2 and R1-R5 stated the facility is fumigated once a month by an exterminator. LPA Bunker requested copies of Roger Pest Control invoices, staff, and resident roster. The invoices dated 11/02/2023 showed room 1 was treated for bedbugs. The invoice dated 12/20/2023 reported rooms 1, 6, and 17 were treated for bedbugs. The invoices dated 01/10/2024, reported there were no bedbugs in the facility. S1-S2 stated the bedbugs in those rooms were reported to the appropriate agencies. See continued LIC9099-C page 2.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Pamela Bunker
LICENSING EVALUATOR SIGNATURE:	DATE: 01/31/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/31/2024

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-20240125103129

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: LONG BEACH RESIDENTIAL	FACILITY NUMBER: 198602620
	VISIT DATE: 01/31/2024

NARRATIVE

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Continued LIC9099-C page 2

Allegation 1: Staff did not prevent pests in the resident's room. Staff 1-2 (S1-S2) and residents 1-5 (R1-R5) interviewed stated the facility had bed bugs. The facility currently doesn't have any bedbugs. We toured the facility, and during today's visit, we did not observe any bed bugs. S1-S2 and R1-R5 stated the facility is fumigated once a month by an exterminator. S1-S2 stated the incident was reported to Community Care Licensing prior to the complaint.

Allegation 2: Staff are threatening a resident. Staff 1-2 (S1-S2), and residents 1-5 (R1-R5) interviewed stated staff is not threatening any residents and that they never witnessed any resident being threatened at the facility by staff. S1-S2 and R1-R5 stated residents are treated with dignity and respect. S1-S2 stated the facility has a zero-tolerance policy. Physical or verbal abuse is not allowed. S1-S2 and R1-R5 stated residents are provided with a safe, healthful, and comfortable environment. Residents are free from corporal or unusual punishment, infliction of pain, humiliation, intimidation, ridicule, coercion, threat, mental abuse, or other actions of a punitive nature. S1-S2 and R1-R5 denied the allegation.

Allegation 3: Staff are not administering the resident's medication.
Staff 1-2 (S1-S2) and residents 1-5 (R1-R5) interviewed stated staff are administering the resident's medication according to their doctor's order. Medication was observed records were accurate and medications were been dispensed according to the doctor's orders and documented as required. S1-S2 and R1-R5 denied the allegation.

See continued LIC9009-C page 2

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Pamela Bunker
LICENSING EVALUATOR SIGNATURE:	DATE: 01/31/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/31/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 4

Control Number 11-AS-20240125103129

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: LONG BEACH RESIDENTIAL	FACILITY NUMBER: 198602620
	VISIT DATE: 01/31/2024

NARRATIVE

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Continued LIC9099-C page 3

Allegation 4; Staff left residents unattended.
Staff 1-2 (S1-S2) and residents 1-5 (R1-R5) interviewed stated residents are never left unattended and staff is always available to provide assistance to residents. S1-S2 stated this is a 24-hour care facility that operates, 7 days a week, 365 days a year. Residents are never left at the facility alone without supervision. The facility has three shifts 8:00 A.M. - 5:00 P.M., 9:30 A.M.- 7:30 P.M.; and 7:30 P.M.- 8:30 A.M.; Sunday through Saturday. The Administrator and Assistant Administrator are on call 24 hours a day. S1-S2 and R1-R5 denied the allegation. See continued LIC9009-C page 2

Allegation 5: Staff are not providing comfortable accommodations for residents.
Staff 1-2 (S1-S2) and residents 1-5 (R1-R5) interviewed stated residents are provided with a safe, healthful, comfortable living environment, equipped with the necessary accommodations to meet their daily needs. S1-S2 and R1-R5 denied the allegation.

Investigation revealed the following: Staff 1-2 (S1-2) and residents 1-5 (R1-R5) interviewed stated the facility is fully staffed and all residents are treated with dignity and respect. R1-R5 stated they do not have any bedbugs in their rooms.

S1-S2 interviewed stated in December 2023, it was identified that a few rooms within the facility may have experienced bedbugs. Roger Pest Control conducted a thorough inspection and treated those rooms. Staff removed affected items, and the rooms were fumigated. S1-S2 stated by the end of December 2023, the facility successfully eradicated the bedbug presence, and this resolution was reported to all relevant agencies, ensuring compliance before the receipt of any complaints. During today's visit we toured the facility. We did not observe any bedbugs.

See continued LIC812-C page 4

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Pamela Bunker
LICENSING EVALUATOR SIGNATURE:	DATE: 01/31/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/31/2024

LIC9099 (FAS) - (06/04)

Page: 4 of 4

Control Number 11-AS-20240125103129

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 1000 CORPORATE DR #100
MONTEREY PARK, CA 91754

FACILITY NAME: LONG BEACH RESIDENTIAL	FACILITY NUMBER: 198602620
	VISIT DATE: 01/31/2024

NARRATIVE

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Continued LIC812-C page 4

S1-S2 stated the facility is committed to maintaining a safe and respectful environment for all residents, underscored by their strict zero-tolerance policy towards any form of intimidation or threats from staff. R1-R5 stated staff do not threaten residents, and they never witness a resident being threatened by staff. R1-R5 stated staff is dispensing their medications according to the doctor's orders. S1-S2 stated staff is trained in dispensing medications. S1-S2 ensures that medication dispensation strictly follows the directives of each resident's physician.

S1-S2 stated as a 24/7 operation, staff is available around the clock, every day of the year, guaranteeing that residents are never left unattended. R1-R5 stated staff is always available to assist residents. S1-S2 and R1-R5 stated staff is providing comfortable accommodations to their residents and denied all allegations. S1-S2 stated their staff is a dedicated team that is providing the necessary care and supervision to care for the safety of all residents.

Based on interviews, available evidence, observation, information received, and records reviewed there was not enough sufficient evidence to support the allegation. 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 deemed unsubstantiated.

A copy of the Complaint Investigation Report LIC9099, and LIC9099-C, was provided to Administrator. There were no deficiencies cited. Exit interview conducted.

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Pamela Bunker
LICENSING EVALUATOR SIGNATURE:	DATE: 01/31/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/31/2024

LIC9099 (FAS) - (06/04)

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