Regency Palms Long Beach

We haven’t transcribed this report yet. The complete document is on the state’s site.

We haven’t transcribed this report yet. The complete document is on the state’s site.

We haven’t transcribed this report yet. The complete document is on the state’s site.

Allegation investigated: Illegal eviction

On September 14, 2026, the California Department of Social Services/Community Care Licensing (CDSS/CCL) Licensing Program Analyst (LPA), Ernand Dabuet, conducted a subsequent unannounced complaint visit. Robert Jakini, Executive Director, greeted the LPA. (LPA) explained that the purpose of the visit is to investigate the allegations mentioned above. The investigation included collecting documents and conducting a tour of the facility. A review of the Personnel Roster (dated 09/14/26), Resident Roster (dated 09/14/26), Resident #1 (R1's) Resident Lease Agreement, Physician's Report for Residential Care Facilities LIC 602A, Service Plan, Resident Assessment, Resident Notes & Incidents,30-Day Notice to Terminate and other pertinent records associated with this complaint. Interviews were conducted with Resident #1 (R1) and Executive Director (ED). (Evaluation Report continues LIC 9099-C) Unsubstantiated INVESTIGATION REVEALED THE FOLLOWING: Allegation: Illegal Eviction. It alleged that Resident #1 (R1) was served with an Illegal Eviction. Reports indicated that (R1) was served with a 30-Day Eviction on August 11, 2026. No further details regarding this matter. On September 14, 2026, between 9:30 AM and 10 AM, the Department interviewed Executive Director identified as (ED). The Executive Director (ED) confirmed that on August 11, 2026, Regency Palms issued a formal 30-Day Notice to Terminate Resident #1 (R1). This notice outlines the procedure for notifying residents in writing and ensures all official communications are properly delivered. It states the grounds for the eviction and the reasons for this decision. Furthermore, the document indicates the importance of conducting the relocation process in accordance with established regulatory standards to ensure that all legal requirements are fulfilled. The notice states that (R1) must move from or surrender the premises from the community by September 11, 2026, which is the termination date. On September 14, 2026, at 11:55 AM and 12:20 PM the Department interviewed Resident member identified as Resident #1 (R1). (R1) confirmed receipt of the 30-Day Notice to Terminate on August 11, 2026. (R1) disputes the reason for the decision, stating that the facility cannot meet the dietary recommendations and requirements. (R1) mentioned to have submitted an Appeal in response to the Notice on August 27, 2026. The Department reviewed the 30-Day Notice to Terminate (dated 08/11/26) and confirmed it complies with Title 22, Section 87244-Eviction Procedures; it outlines the requirements for notifying a resident in writing, serving proper Notice, stating reasons for eviction, and ensuring relocation is conducted in accordance with regulatory requirements. Further review of (R1’s) Physicians Report LIC602A (dated 05/09/24) Service Plan (dated 07/24/25), Resident Assessment (dated 09/11/26 & 06/23/26), DHCS Individual Service Plan (dated 06/26/24), and Facility Notes & Incidents (dated 07/02/25 & 07/22/26) all reports dd not list (R1) “required special diets”. Further review of several physician medical notes (dated 08/21/26, 01/27/26, 08/04/26 & 10/03/25) indicates to only provide recommendations and advised seeking guidance from a nutritionist or dietitian - nowhere it indicates (R1) is on "special diet". The California Department of Social Services complaint #11-AS-20260730100723 has addressed (R1's) dietary restrictions which determined that the allegation was unsubstantiated. Interviews with the Executive Director (ED) and the resident (R1) indicated that the facility adhered to established procedures and involved the resident in the discharge process. (Evaluation Report continues LIC 9099-C) The (ED) denied any evictions outside Title 22 requirements. (R1's) statements were consistent with the (ED's), confirming that (R1) received formal notice and understood the reasons for the proposed discharge. During the investigation, the Department observed (R1) is still resides at the facility and has not been removed from the premises. Based on file review, interviews, and observations, there was insufficient evidence to support the allegation. Based on the information collected from the facility inspection, observations, interviews, and records analysis, the Department found no evidence to support the above allegation. The allegation may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred. Therefore, the allegation is Unsubstantiated. No deficiencies cited. An exit interview was conducted with Robert Jakini, and copies of the reports were provided.the state’s words, verbatim · CDSS document, Sep 14, 2026 · control 11-AS-20260910082634

Allegation investigated: Staff do not ensure a resident is provided a safe and comfortable environment. Staff mismanage residents medication. Staff do not prevent resident from yelling at another resident.

On 08/28/26 at 9:00 am Licensing Program Analyst (LPA) Villegas conducted an initial complaint visit regarding the allegation(s) above. LPA met with Executive Director Robert Jakini (staff #1/S1) as the purpose of today’s visit was explained. The investigation consisted of the following: On 08/28/26 LPA Villegas obtained copies of the staff and resident roster, house rules, and copies of the following documents for Resident #1 (R1) Emergency ID form, Assessment dated: 06/24/26, Physicians report dated: 04/28/26, Service plan dated: 08/2026, medication list, medication administration records (MAR) for July 2026-August 2026, controlled drug record, and facility notes from May 2026-August 2026. On 08/28/26 from 10:00 am- 11:20 am LPA conducted Interviews with Resident # 1-7 (R1-R7), LPA attempted to interview R2 but could not due to communication barriors. LPA conducted interviews with Staff #1-5 (S1-S5) from 1pm- 2pm. LPA conducted a tour of R1's bedroom, and conducted a review of MARs. Unsubstantiated The investigation revealed the following: Allegation: Staff do not ensure a resident is provided a safe and comfortable environment. it is alleged that a resident in care is being offered to move a to a room that has insufficient space to accommodate (2) residents, the resident's belongings, and mobility needs. On 08/28/26 from 10:00 am- 11:20 am LPA conducted Interviews with R1-R7 regarding the allegation above. 5 of the 7 residents interviewed denied the allegation above and reported that they have enough space for their belongings and enough space to move easily throughout the bedroom. 1 of the 7 residents confirmed the allegation above and reported that they do not have enough space for their belongings nor mobility needs in the proposed bedroom. However, 1 of 7 residents interviewed stated that in their current bedroom they have enough space. 1 of the 7 residents could not be interviewed due to communication barriers. LPA conducted interviews with S1-S5 regarding the allegation above. 5 of the 5 staff interviewed denied the allegation above and reported that shared bedrooms are large enough to accommodate (2) residents. Per staff, residents in shared rooms each have a closet and a dresser, and rooms are large enough to accommodate residents who have walkers, and/or wheelchairs. Additionally, 2 of 5 staff interviewed stated that if a resident is on a program that assist with rent, then resident is automatically placed in a shared room as programs do not pay for private bedrooms. On 08/28/26 LPA conducted tour of shared bedroom and observed that shared bedroom to have to closets, 2 night stands, a dresser, and bedrooms were observed to have wider hallways, and doors to accommodate mobility needs. Allegation: Staff mismanage residents medication. It is alleged that resident in care is not receiving Narcotic PRN when requested. On 08/28/26 from 10:00 am- 11:20 am LPA conducted Interviews with R1-R7 regarding the allegation above. 5 of the 7 residents interviewed denied the allegation above and reported they are receiving their medications. Additionally, 5 of 7 residents reported that they do not have any concerns about how their medications are handled. 1 of the 7 residents confirmed the allegation above and reported that when narcotic PRN is requested, staff is not providing it. 1 of the 7 residents could not be interviewed due to communication barriers. LPA conducted interviews with S1-S5 regarding the allegation above. 3 of the 5 staff interviewed denied the allegation above, and reported that all medications and PRNs are being administered per Doctors orders. 2 of the 5 staff interviewed did not have knowledge of the allegation as they do not assist with medication administration. On 08/28/26 LPA conducted a review of MAR for July 2026-August 2026, and controlled drug record. Upon review, it was observed that resident in care is receiving narcotic PRN daily. Allegation: Staff do not prevent resident from yelling at another resident. It is alleged that a resident in care has significant stress due to another residents ongoing yelling behavior. On 08/28/26 from 10:00 am- 11:20 am LPA conducted Interviews with R1-R7 regarding the allegation above. 4 of the 7 residents interviewed denied the allegation above and reported not having any issues with other residents in care. 1 of 7 residents reported having a discussion with another resident and that staff had to remind the other resident to be respectful. 1 of the 7 residents confirmed the allegation above and reported that staff has been made aware of the stress caused by another resident but staff have not done anything about it as staff favors the other resident in care. 1 of the 7 residents could not be interviewed due to communication barriers. LPA conducted interviews with S1-S5 regarding the allegation above. 5 of the 5 staff interviewed denied the allegation above and reported that residents are separated, spoken to, and reminded of the house rules when residents are observed in a confrontation. LPA reviewed house rules, per house rule bullet point #7, residents are to be thoughtful and considerate of others in the Community with appropriate language, comments, or remarks. Please refrain from any aggressive or disrespectful communication or behaviors. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated. Exit interview conducted, and a copy of this report was provided.the state’s words, verbatim · CDSS document, Aug 28, 2026 · control 11-AS-20260823102415

Allegation investigated: Staff does not allow resident to have private visits. Staff restrict residents’ ability to leave the facility for personal outings.

On August 18, 2026, the California Department of Social Services/Community Care Licensing (CDSS/CCL) Licensing Program Analyst (LPA), Ernand Dabuet, conducted an initial unannounced complaint visit. Robert Jakini, Executive Director, greeted the LPA. (LPA) explained that the purpose of the visit is to investigate the allegations mentioned above. The investigation included collecting documents and conducting a tour of the facility. A review of the Personnel Roster (dated 08/18/26), Resident Roster (dated 08/18/26), Resident #1 (R1's) Residency Agreement (dated 05/22/26) , Medical Assessment for Residential Care Facilities LIC 602A (dated 05/13/26), Service Plan (dated 05/15/26), Visitor's Log (date 06/27/26 through 08/17/26), and other pertinent records associated with this complaint. Interviews were conducted with Resident #1 through Resident #6 and Staff #1 and Staff #2. (Evaluation Report continues LIC 9099-C) Unsubstantiated INVESTIGATION REVEALED FOLLOWING: Allegation #1: Staff does not allow resident to have private visits. It is alleged that Resident #1 (R1) does not allow residents to have private visits. Reports indicated that (R1) was not allowed a private visit on July 11, 2026, and that visits must be conducted with the responsible party. Additionally, the court ruling allowing (R1) unrestricted visitation was not granted. No further information was provided regarding this matter. On August 18, 2026, between 9:30 AM and 10:30 AM, the Department conducted interviews with two staff members, identified as Staff #1 and Staff #2 (S1 and S2). Two (2) out of the two (2) staff members confirmed that there are no restrictions preventing resident (R1) from having private visits. They indicated that residents are allowed to have visitors and can meet in private areas, such as their rooms or designated visitation spaces. Staff members explained that they do not interfere with or restrict private visits unless mandated by a court order, care plan, or safety concern. In the case of (R1), there is a court order with specific stipulations. These include that visits cannot exceed ninety (90) minutes, no more than two (2) persons may visit the conservatee at a time, and no disparaging comments are allowed during visitation. On July 11, 2026, a guest for (R1) violated several of these terms on a visit on July 8, 2026, leading (R1's) conservator to deny visitation rights in accordance with the court order. Furthermore, (S1) stated according to (R1)’s Residency Agreement if guests are abusive to residents or staff, we may ask them to leave, limit their visits, or ban them from the Community. On August 18, 2026, between 10:35 AM and 11:40 AM, the Department interviewed residents identified as Residents #1 through #6 (R1-R6). Six (6) out of the six (6) residents confirmed that they have not experienced any restrictions on visits. They reported that visits are permitted and that staff have not obstructed private visitation. (R1) stated that there are no issues or concerns regarding visits and noted that staff make accommodations to ensure privacy during visits. On August 18, 2026, between 12:30 PM and 1:05 PM, the Department interviewed a witness identified as Witness #1 (W1), who is the responsible party for (R1). (W1) could not validate the claim. (W1) emphasized that guests are afforded privacy during their visits with (R1) and highlighted the existence of a Superior Court of California order. (Evaluation Report continues LIC 9099-C) This order mandates that those listed adhere strictly to the visitation conditions outlined in the agreement. Any violation of these terms could result in the suspension of visitation rights. (W1) reported in the case of guest on July 8, 2026, had violated these terms and was denied visitation on July 11, 2026. The Department reviewed (R1) 's Residency Agreement (dated 05/22/26), which indicated in sections 4-4.1 and 4.3, "If your guests become disruptive to the operations of the Community and/or are verbally or physically abusive to Residents, our staff, or others, we may request that they leave the Community until their behavior is under control or may restrict their visitation." A review of Medical Assessment LIC 602A (dated 05/13/26), Resident Assessment (dated 05/15/26), Superior Court of California, County of Los Angeles Court Order (dated 09/27/23 and 01/05/26) verified (R1's) lack of capacity to make own decisions and verification of visitation terms and conditions. Additional review of Superior Court of California, County of Los Angeles Letters of Conservatorship (dated 11/22/23) verifies (W1) as the responsible party for (R1). Facility email documentation (dated 07/14/26) verified that (R1)'s guest violated the terms and conditions of the court order. Further review of Facility's Visitor's Log (dated 06/27/26 through 08/17/26) verified that (R1) is visited from individuals listed on court order. Based on the information obtained, there is insufficient evidence to support the allegation that staff does not allow the resident private visits. Allegation #2: Staff restrict residents’ ability to leave the facility for personal outings. It is alleged that Resident #1 (R1) is restricted by staff from leaving for personal outings. Reports indicated that facility staff are directed to call the responsible party for visits whenever guests seek to arrange a visit. This often results in the responsible party for (R1) arriving before the guest, leading to denied visits on August 11, 2026. No further information was provided regarding this matter. On August 18, 2026, between 9:30 AM and 10:30 AM, the Department conducted interviews with two staff members, identified as Staff #1 and Staff #2 (S1 and S2). Two (2) out of the two (2) staff members unable to validate this claim. Both staff indicated that residents are permitted to leave the facility for personal outings and activities of their choice, provided it is safe to do so and consistent with the residents’ care plan. On August 11, 2026, (R1) already had scheduled plan with the responsible party and was taken out of the community. The facility did have any control of guests scheduling visits who arrived that day when (R1) was out in the community. (Evaluation Report continues LIC 9099-C) Staff stated they do not prevent residents from going on outings and assist residents with arranging transportation when needed. On August 18, 2026, between 10:35 AM and 11:40 AM, the Department interviewed residents identified as Residents #1 through #6 (R1-R6). Six (6) out of the six (6) residents verified staff do not interfere with their personal outings and are able to leave the facility freely. None of the interviewed residents reported that staff prevented or discouraged them from leaving for personal activities. (R1) expressed can leave the facility with visitors with no issues or concerns. On August 18, 2026, between 12:30 PM and 1:05 PM, the Department interviewed a witness identified as Witness #1 (W1). W1 stated that they had already scheduled an outing with Resident #1 (R1) for August 11, 2026, which just coincided with a guest plan visit. Staff did not intentionally restrict R1's ability to leave the community with specific individuals. However, (W1) emphasized that a current court order imposes clear terms and conditions that all involved must adhere to. The Department reviewed (R1) 's Residency Agreement (dated 05/22/26). A review of Medical Assessment LIC 602A (dated 05/13/26), Resident Assessment (dated 05/15/26), Superior Court of California, County of Los Angeles Court Order (dated 09/27/23 and 01/05/26) verified (R1's) lack of capacity to make own decisions and inability to leave the facility unsupervised, and the terms and conditions of the court order. Additional review of Superior Court of California, County of Los Angeles Letters of Conservatorship (dated 11/22/23) verifies (W1) as the responsible party for (R1). Facility email documentation (dated 07/14/26) verified that (R1)'s guest violated the terms and conditions of the court order. Further review of the Facility's Visitor's Log (dated 06/27/26 through 08/17/26) verified that (R1) was visited by individuals listed on the court order. Based on the information gathered, there is not enough evidence to support the allegation that staff restrict residents’ ability to leave the facility for personal outings. Based on the information collected from the facility inspection, observations, interviews, and records analysis, the Department found no evidence to support the above allegation. The allegations may have happened or are valid, but there is not a preponderance of the evidence to prove that the alleged violations occurred. Therefore, the allegations are unsubstantiated. No deficiencies cited. An exit interview was conducted with Robert Jakini, and copies of the reports were provided.the state’s words, verbatim · CDSS document, Aug 18, 2026 · control 11-AS-20260814110318

Allegation investigated: Staff did not ensure a fall plan was put in place after resident had prior falls resulting in a brain bleed

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 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. 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. & 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-Cthe state’s words, verbatim · CDSS document, Aug 6, 2026 · control 11-AS-20251217122530

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87463(b)(1) · Plan of correction due date: Aug 7, 2026

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 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.the state’s words, verbatim · CDSS document, Aug 6, 2026

Plan of correction: 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 An immediate $500 civil penalty assessed.

Type of visit: Case Management - Deficiencies

On 08/04/2026, at 12:30pm, Licensing Program Analyst (LPA) Zina Brown conducted a Case Management for complaint Control Number 11-AS-20251217122530. LPA met with Robert Jakini, Administrator, as the purpose of the visit was explained. LPA reviewed the facility’s reporting history and progress notes related to R1’s documented falls and observed the following: On October 30, 2025, R1 sustained a fall resulting in a quarter-size hematoma above the right eye; EMS and family were notified. On November 8, 2025, R1 fell out of bed and sustained a hematoma to the back of the head and was transported to St. Mary’s. On December 14, 2025, R1 sustained an unwitnessed fall at 0515 hours and was assisted back to bed. On December 15, 2025, R1 sustained an unwitnessed fall in the bathroom, complained of head pain, and was transported to the hospital where an intracranial hemorrhage was identified. The Department received the incident reports for the falls dated November 08, 2025 & December 15, 2025. On August 6, 2026, between the hours of 9:15am - 10:15am, the Department requested incident reports for 10/30/2025, 12/14/2025 & 12/15/2025. As a result, the facility failed to report 2 incidents that occurred with R1 such as On 10/30/2025 at 9:31pm (last updated by staff on 10/31/2025 at 4:06 am), R1 who sustained a quarter-size hematoma above the right eye; EMS and family were called according the progress notes which does not explain the cause of hematoma. On 12/14/2025 at 5:30am, R1 had an unwitnessed fall at 05:15am with no injuries noted and was assisted back in bed. Deficiency cited under California Code of Regulation Title 22 Division 6 Chapter 8 are being cited on the attached LIC 809-D. Exit interview conducted Robert Jakini (Administrator), appeal rights explained, and a copy of this report was provided.the state’s words, verbatim · CDSS document, Aug 6, 2026

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87211(a)(1) · Plan of correction due date: Aug 10, 2026

Reporting Requirements(a)(1)Each licensee shall submit serious incident reports to. . . the Department may require, including the following: (1) A written report shall be submitted to the licensing agency & to the person responsible for the resident within 7 days of the occurrence of any of the events This requirement was not met as evidenced by: based observation, LPA observed that the facility did submit a LIC 624 to the department within 7 day of incidents that occurred on 10/30/2025 & 12/14/2025.the state’s words, verbatim · CDSS document, Aug 6, 2026

Plan of correction: The facility shall will submit a serious incident reports for the incidents that occur on 10/30/2025 & 12/14/2025 for Resident 1 (R1) The report must be fax to 424-544-1016 to department by POC due date.

Allegation investigated: Staff left resident in soiled clothing. Staff threw a phone at resident.

On August 4, 2026, the California Department of Social Services/Community Care Licensing (CDSS/CCL) Licensing Program Analyst (LPA), Ernand Dabuet, conducted a subsequent unannounced complaint visit. Robert Jakini, Executive Director, greeted the LPA. (LPA) explained that the purpose of the visit is to investigate the allegations mentioned above. The investigation included collecting documents and conducting a tour of the facility. A review of the Personnel Roster (dated 08/03/26), Resident Roster (dated 08/03/26), Resident #1 (R1's) Resident Lease Agreement, Physician's Report for Residential Care Facilities LIC 602A, Service Plan (dated 05/04/26), Resident Notes & Incidents, and other pertinent records associated with this complaint. Interviews were conducted with Resident #1 through Resident #7, Staff #1,and Staff #2 . (Evaluation Report continues LIC 9099-C) Unsubstantiated INVESTIGATION REVEALED THE FOLLOWING: Allegation #1: Staff left resident in soiled clothing. It has been reported that staff left Resident #1 (R1) in soiled clothing. Reports indicate that (R1) was not assisted with diaper changes and was left in soiled clothing. No additional information has been provided regarding this matter. On August 3, 2026, between 9:30 AM and 01:20 PM, the Department interviewed staff members identified as Staff #1 and Staff #2 (S1-S2). Two (2) out of the two (2) staff members cannot support this allegation. (S1-S2) stated that residents are routinely checked for their incontinence needs and are promptly assisted when care is required. It has been reported that (R1) receives regular help with activities of daily living (ADLs), such as toileting and changing clothing, and is never left in soiled garments. (R1) medical assessments to determine (R1) ability to manage personal toileting needs. The service plan indicates that (R1) is independent and can self-care; however, if assistance is needed, it is provided. On August 3, 2026, between 10:15 AM and 12:45 PM, the Department interviewed residents identified as Resident #1 through Resident #7 (R1-R7). Seven (7) out of the seven (7) residents could not support this claim. (R1-R7) claimed to have concerns of neglect or delayed care. (R1) was interviewed and denied making any statements regarding incontinence care. The Department reviewed (R1’s) Medical Assessment for Resident Care Facilities LIC 602A (dated 04/28/26), Service Plan (dated 05/29/26), Notes & Incidents Resident Summary (dated 05/30/26 through 08/03/26) and did not find entries indicating the resident was left in soiled clothing or not assisted in a timely manner. It also verified that (R1) can self-care with toileting needs. The Department also conducted observations during the visit. (R1) appeared clean, properly dressed, and no signs of neglect were observed. Based on interviews, record review, and observations, there was insufficient evidence to support the allegation mentioned above. (Evaluation Report continues LIC 9099-C) Allegation #2: Staff threw a phone at resident. It is alleged that staff threw a phone at Resident #1 (R1). Reports indicate that on July 30, 2026, when (R1) handed the staff the telephone to speak with a party regarding (R1's) ineligibility, the staff took the phone but did not listen to the conversation. Instead, the staff threw the phone back at (R1). No additional information has been provided regarding this matter. On August 3, 2026, between 9:30 AM and 01:20 PM, the Department interviewed staff members identified as Staff #1 and Staff #2 (S1-S2). Two (2) out of the two (2) staff cannot validate this claim. (S1-S2) indicated that no staff member recalled any incident involving a phone being thrown at (R1). (S2) who was working on July 30, 2026, and recalled walking in on (R1) telephone conversation. Staff denied behaving aggressively or inappropriately toward (R1). (S1) reported no known incidents of staff physically mishandling objects or acting in a threatening manner toward (R1). On August 3, 2026, between 10:15 AM and 12:45 PM, the Department interviewed residents identified as Resident #1 through Resident #7 (R1-R7). Seven (7) out of the seven (7) residents could not support this claim. (R1-R7) disclosed that they did not witness staff throwing items at residents or engaging in hostile behavior. No resident stated that they observed or experienced staff acting in a manner consistent with the allegation. (R1) was interviewed and denied making any statements regarding inappropriate behavior by staff. The Department reviewed the Notes & Incidents Resident Summary for R1, covering the period from May 30, 2026, to August 3, 2026. The review found no reports, notes, or records indicating any physical altercations or misconduct involving staff. Additionally, an examination of the Medical Assessment for Resident Care Facilities (LIC 602A) (dated April 28, 2026), Service Plan (dated May 29, 2026), and observations made during the visit did not reveal any concerns regarding staff behavior. Staff members were observed professionally interacting with residents. Based on interviews, record review, and observations, there was insufficient evidence to support the allegation mentioned above. Based on the information collected from the facility inspection, observations, interviews, and records analysis, the Department found no evidence to support the above allegation. The allegation may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred. Therefore, the allegation is Unsubstantiated. No deficiencies cited. An exit interview was conducted with Robert Jakini, and copies of the reports were provided.the state’s words, verbatim · CDSS document, Aug 4, 2026 · control 11-AS-20260730151941

Allegation investigated: Staff do not distribute a resident's medication as prescribed. Staff do not safeguard a resident's personal belongings. Staff do not assist resident with showering.

On August 4, 2026, the California Department of Social Services/Community Care Licensing (CDSS/CCL) Licensing Program Analyst (LPA), Ernand Dabuet, conducted a subsequent unannounced complaint visit. Robert Jakini, Executive Director, greeted the LPA. (LPA) explained that the purpose of the visit is to investigate the allegations mentioned above. The investigation included collecting documents and conducting a tour of the facility. A review of the Personnel Roster (dated 08/03/26), Resident Roster (dated 08/03/26), Resident #1 (R1's) Residency Lease Agreement, Physician's Report for Residential Care Facilities LIC 602A, Service Plan (dated 05/04/26), Resident Notes & Incidents, and other pertinent records associated with this complaint. Interviews were conducted with Resident #1 through Resident #7 and Staff #1 through Staff #3. (Evaluation Report continues LIC 9099-C) Unsubstantiated INVESTIGATION REVEALED THE FOLLOWING: Allegation #1: Staff do not distribute a resident's medication as prescribed. It has been reported that staff did not administered Resident #1 (R1’s) prescribed medication. Reports indicated the staff are not administering (R1’s) skin medication. No additional information has been provided regarding this matter. On August 3, 2026, and August 4, 2026, between 9:30 AM and 01:20 PM, the Department interviewed staff members identified as Staff #1 through Staff #3 (S1-S3). Three (3) out of the three (3) staff members could not support this claim. Interviews with staff indicated that medications are administered according to physician orders documented on the Medication Administration Record (MAR). (S1-S3) denied missing doses or altering medication administration times and stated they follow facility medication procedures, including double-checking medication labels and documenting administration immediately after dispensing. (S2) indicated that (R1) does not have a prescribed skin medication from (R1’s) medical physician. (S2) mentioned that (R1) might not have been received prompt attention because (R1) refused or is out in the community, and this is noted on the (MAR). On August 3, 2026, and August 4, 2026, between 10:15 AM and 12:45 PM, the Department interviewed residents identified as Resident #1 through Resident #7 (R1-R7). Six (6) out of the seven (7) residents could not support this claim. (R2-R7) interviewed did not reveal concerns regarding medication administration. No residents reported missing doses or receiving medications incorrectly. (R1) mentioned that skin medication, pain reliever, and sleep aids were not administered on time. (R1) was unable to specify when these delays occurred or which staff were involved but confirmed that the timing of the prescribed medications does not align with (R1’s) schedule. The Department reviewed the (R1’s) (MAR) (dated 07/01/26 through 07/31/26) records show the pain reliever and sleep aid medications as (R1) refusal or out in the community. It did not show discrepancies between physician orders and recorded administration. Centrally stored medication logs matched medication counts, and no irregularities were observed in the medication storage area. Additionally, an examination of the Medical Assessment for Resident Care Facilities (LIC 602A) dated April 28, 2026, the Service Plan (dated 05/29/26). (Evaluation Report continues LIC 9099-C) Based on interviews, record review, and observations, there was insufficient evidence to support the allegation mentioned above. Allegation #2: Staff do not safeguard a resident's personal belongings. It is alleged that the staff did not safeguard Resident #1 (R1's) personal belongings. Reports indicate that (R1's) belongings are missing, although the specific items have not been identified. No additional information has been provided regarding this matter. On August 3, 2026, and August 4, 2026, between 9:30 AM and 01:20 PM, the Department interviewed staff members identified as Staff #1 through Staff #3 (S1-S3). Three (3) out of the three (3) staff members could not validate this claim. Interviews with staff revealed that residents' personal belongings are kept in their rooms, and staff only handle or remove items when assisting with cleaning or organization. Staff members (S2-S3) mentioned that items confiscated from (R1) included non-prescription supplements, skin ointment, an energy drink and a vape. The energy drink was removed because of (R1's) health issue. On August 3, 2026, and August 4, 2026, between 10:15 AM and 12:45 PM, the Department interviewed residents identified as Resident #1 through Resident #7 (R1-R7). Six (6) out of the seven (7) residents could not corroborate this claim. (R2-R7) they have not witnessed belonging being taken, misplaced or mishandled. Furthermore, they did not have concerns about staff failing to safeguard belongings. No resident stated that their personal items had been taken, lost, or handled inappropriately by staff. (R1) reported that staff took personal items like vitamins, ointments, and drinks and did not return them. (R1) mentioned that family members brought these items in during visits and did not have prescriptions for them. The Department reviewed (R1's) Residency Lease Agreement, dated May 29, 2026. On page 38, under the section titled "Loss or Damage of Personal Property," it states, "We encourage residents to purchase insurance for their belongings, as the facility cannot guarantee the safety of personal property." This section includes (R1's) acknowledgment signature. Further review of Resident Personal Property and Valuables LIC 621 (dated 05/07/26) did not have any personal property or valuable items listed. On August 3, 2026, the Department inspected (R1's) room and found personal belongings organized and intact, with no signs of tampering or neglect. (Evaluation Report continues LIC 9099-C) Based on interviews, record review, and observations, there was insufficient evidence to support the allegation mentioned above. Allegation #3: Staff do not assist resident with showering. It is alleged that staff do not assist Resident #1 (R1) with showering. Reports indicated that (R1) is not given enough time to shower or it is not done promptly. No additional information has been provided regarding this matter. On August 3, 2026, and August 4, 2026, between 9:30 AM and 01:20 PM, the Department interviewed staff members identified as Staff #1 through Staff #3 (S1-S3). Three (3) out of the three (3) staff members could not validate this claim. Interviews with staff indicated that residents are assisted with bathing according to their Services Plan. Staff reported that the (R1) receives regular assistance with showering. (S2-S3) stated that (R1) receives bathing assistance two times per week, specifically on Monday and Wednesday, between 6 AM and 2 PM. (S2-S3) denied refusing or failing to assist the resident with personal hygiene care. On August 3, 2026, and August 4, 2026, between 10:15 AM and 12:45 PM, the Department interviewed residents identified as Resident #1 through Resident #7 (R1-R7). Six (6) out of the seven (7) residents could not support this claim. (R2-R7) interviewed did not reveal concerns regarding bathing assistance. No resident reported being denied help with showering or being left without necessary personal care. The Department reviewed facility’s Shower Schedule, Medical Assessment for Resident Care Facilities (LIC 602A) dated April 28, 2026, the Service Plan (dated 05/29/26) and Notes & Incidents – Resident Summary (dated 05/30/26 through 08/03/26). Records showed that staff assisted the resident with showering consistently with the (R1’s) care plan. No missed bathing entries or gaps in documentation were found. During the visit on August 3, 2026 and August 4, 2026, the Department observed the resident to appear clean and appropriately groomed. Based on interviews, record review, and observations, there was insufficient evidence to support the allegation mentioned above. Based on the information collected from the facility inspection, observations, interviews, and records analysis, the Department found no evidence to support the above allegation. The allegation may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred. Therefore, the allegation is Unsubstantiated. No deficiencies cited. An exit interview was conducted with Robert Jakini, and copies of the reports were provided.the state’s words, verbatim · CDSS document, Aug 4, 2026 · control 11-AS-20260803113400

Allegation investigated: Staff are not following resident's dietary restrictions. Staff are not following resident's admissions agreement.

On August 4, 2026, the California Department of Social Services/Community Care Licensing (CDSS/CCL) Licensing Program Analyst (LPA), Ernand Dabuet, conducted a subsequent unannounced complaint visit. Robert Jakini, Executive Director, greeted the LPA. (LPA) explained that the purpose of the visit is to investigate the allegations mentioned above. The investigation included collecting documents and conducting a tour of the facility. A review of the Personnel Roster (dated 08/03/26), Resident Roster (dated 08/03/26), Resident #1 (R1's) Resident Lease Agreement, Physician's Report for Residential Care Facilities LIC 602A, Service Plan (dated 05/04/26), Resident Notes & Incidents, and other pertinent records associated with this complaint. Interviews were conducted with Resident #1 through Resident #7, Staff #1,and Staff #2 and Witness #1. (Evaluation Report continues LIC 9099-C) Unsubstantiated INVESTIGATION REVEALED THE FOLLOWING: Allegation #1: Staff are not following resident's dietary restrictions. It has been reported that staff are not following the dietary restrictions for Resident #1 (R1). Specifically, kitchen staff have allegedly been serving seasoned foods instead of the required low-acidic, non-seasoned meals over the past two weeks. While (R1's) dietary needs were previously accommodated for periods of 6 to 8 weeks, compliance has recently declined. No additional information has been provided regarding this matter. On August 3, 2026, between 9:30 AM and 01:20 PM, the Department interviewed staff members identified as Staff #1 and Staff #2 (S1-S2). Two (2) out of the two (2) staff cannot corroborate this claim. Both staff acknowledged their awareness of residents' dietary restrictions and confirmed that meal plans are regularly updated based on physician documentation. Additionally, (S1-S2) informed that the facility has collaborated with Assisted Dining Solutions to manage nutritional dietary requirements, which validates their menus. (R1) is not classified under a "special diet" prescribed by a physician, as confirmed by (R1's) Physician's Report LIC 602A (dated 05/09/24), which indicates no special dietary needs. While there is a medical note (dated 10/03/25) that is not from (R1's) primary physician, along with a second medical note (dated 01/27/26) from another physician, these documents recommend that (R1) avoid certain foods and food groups. However, they do not specify any clear dietary restrictions. It is suggested that (R1) consult a nutritionist or dietitian to tailor (R1's) diet based on specific symptoms. (S2) shared that the kitchen is partnered with (R1) to ensure all dietary meal requests are met effectively. A comprehensive weekly meal plan has been created, allowing (R1) to review daily options and alternatives. (R1) is encouraged to suggest any changes or additional choices as needed, which will be included in the "weekly meal plan." This plan is readily accessible upon request each week. (S2) emphasized that any disruption in meal accommodations occurs when (R1) does not submit a complete set of requests for the entire week. On August 3, 2026, between 10:15 AM and 12:45 PM, the Department interviewed residents identified as Resident #1 through Resident #7 (R1-R7). Six (6) out of the seven (7) residents could not support this claim. (R2-R7) interviewed did not report receiving meals inconsistent with their dietary restrictions or did not have any dietary restrictions. (Evaluation Report continues LIC 9099-C) (R1) acknowledged that the kitchen has been accommodating (R1's) meal selections based on (R1's) dietary recommendations. However, (R1) expressed concerns about the inconsistency over the past few weeks. Despite this, (R1) appreciates the kitchen staff for being considerate and allowing (R1) the weekly meal plan as a special service solely for (R1). The Department reviewed (R1’s) Physician's Report LIC 602A (dated 05/09/24), which reflected no specified dietary restrictions (e.g., diabetic diet, low-sodium diet). Facility Daily Menus (dated 05/10/26 through 008/08/26) indicated menus approve by Assisted Dining Solutions. Medical Notes (dated 10/03/25 and 01/27/26), Weekly Meal Plan (dated 06/14/26 through 07/25/26), Internal Letter to (R1) RE: Meals and Food Request (dated 10/21/25), and Service Plan (dated 07/29/25). The Department did not observe any meals being served that contradicted documented restrictions during the visit. Based on file review, interviews, and observations, there was insufficient evidence to support the allegation. Allegation #2: Staff are not following resident's admissions agreement. It is alleged that staff are not complying with Resident #1's (R1's) admission agreement. There have been indications that the facility is failing to uphold the agreements made during admission, which guaranteed a one-bedroom unit with a private bathroom. However, the facility has transformed the existing floor into memory care and had (R1) relocate to a shared room, which is insufficient for (R1's) belongings and furniture. No further details have been provided regarding this situation. On August 3, 2026, between 9:30 AM and 10:02 AM, the Department interviewed staff members identified as Staff #1 (S1). (S1) recognized understanding of the Admission Agreement's terms and agreed to adhere to the specified services, which include supervision, help with Activities of Daily Living (ADLs), meal provisions, and the lease agreement. (S1) clarified that the Resident Lease Agreement for (R1) indicates single apartment occupancy. In this regard, "single" does not mean a "private room" as mentioned in the agreement. Furthermore, (R1) is participating in a program that requires a private or semi-private room equipped with a full bathroom, kitchenette, refrigerator, microwave, and sufficient storage space for supplies. (R1) is being moved to a semi-private room on an assisted living floor and is compliant with the Resident Lease Agreement (dated 08/17/24). (Evaluation Report continues LIC 9099-C) On August 3, 2026, between 10:15 AM and 12:45 PM, the Department interviewed residents identified as Resident #1 through Resident #7 (R1-R7). Six (6) out of the seven (7) residents could not corroborate this claim. (R2-R7) interviewed did not reveal concerns that staff failed to provide services as stated in the Admission Agreement and the services listed in their agreement is being provided. (R1) was interviewed and mentioned that she had been occupying a private room but now must move to a shared room. (R1) expressed concerns about accommodating all (R1’s) personal furniture in the new space. (R1) also claimed that the facility violates the Resident Lease Agreement (dated 08/17/24), which notes that (R1) is entitled to a "single" unit. On August 3, 2026, between 01:03 PM and 01:23 PM, the Department interviewed witness identified as Witness #1 (W1). (W1) confirmed that (R1) is a participant of the program and that the program requires a private or semi-private room equipped with a full bathroom, kitchenette, refrigerator, microwave, and sufficient storage space for supplies. (R1) did not have a kitchenette, refrigerator microwave in (R1's) current room and stated that it would benefit for (R1) to have these amenities as (R1) has dietary recommendations. The Department reviewed the Resident #1’s (R1’s) Rental Lease Agreement (dated 08/17/24), DHCS Amenity Form (dated 06/24/24), Regency Palms Memory Care and Assisted Living Floor Plans, Facility Sketch and which documented the services the facility agreed to provide. Review of Service Plans, Admission Record (dated 06/24/24), and Email communications (dated 08/03/26) and staff notes did not show discrepancies between the services promised and the services delivered. The Department inspected memory care room #507, which includes a sleeping area and private bathroom. Assisted living room #803 features a shared hallway with a kitchenette and bath, along with two private bedrooms: bedroom #1A and bedroom #2B, both equipped with storage. The bedrooms are fully separated by floor-to-ceiling walls and doors. Based on file review, interviews, and observations, there was insufficient evidence to support the allegation. Based on the information collected from the facility inspection, observations, interviews, and records analysis, the Department found no evidence to support the above allegation. The allegation may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred. Therefore, the allegation is Unsubstantiated. No deficiencies cited. An exit interview was conducted with Robert Jakini, and copies of the reports were provided.the state’s words, verbatim · CDSS document, Aug 4, 2026 · control 11-AS-20260730100723

Allegation investigated: Facility staff neglect resulted in resident being dropped Facility staff are not keeping accurate records

On 07/22/2026, Licensing Program Analyst (LPA), Wendy Gibbs, conducted an unannounced Complaint Visit to the facility listed above. LPA met with Robert Jakini, Executive Director, and the purpose of today’s visit was explained. LPA was granted entry into the facility. The investigation consisted of the following: During today’s visit, LPA received and reviewed Staff Training Logs During a subsequent visit conducted on 06/30/2026, LPA inspected the facility, interviewed Staff S1, S6-S8, and interviewed Resident R2-R9. During the initial visit conducted on 03/19/2026, LPA interviewed Staff S2-S5 and received documents. The following documents were received and reviewed Staff Roster, Resident Roster, Resident Lease Agreement (dated 12/20/2024), Identification and Emergency Information (dated 12/20/2024), Medical Assessment for Residential Care Facilities for the Elderly (dated07/20/2025), Client/Resident Personal Property and Valuables (dated 12/20/2024), Personal Rights of Residents in Privately Operated Residential Care Facilities for the Elderly (dated 12/20/2024), Resident Assessment (dated 12/31/2025), Service Plan (dated07/29/2025), Alert Report, Unusual Incident/Injury Reports (dated 03/01/2026), and Staff Schedule. Unsubstantiated The investigation revealed the following: Allegation: Facility staff neglect resulted in resident being dropped The allegation alleges that a resident was dropped by staff and did not experience a fall as reported. During the facility inspection, LPA observed staff assisting a resident with getting out of a chair and transferring to a wheelchair. LPA observed staff had their hands appropriately placed to provide support. During record review, LPA received and reviewed an Unusual Incident/Injury Report that states on 03/01/2026 at 5:57am, R1 stated they were reaching for their remote and fell out of bed on their back side. The resident was assessed and checked no injuries to report. Residents Power of Attorney was notified, and the resident spoke with them. Additionally, LPA received and reviewed the Notes for Resident R1 from 04/09/2025 through 03/11/2026 that indicates on 03/01/2026 at 5:57am R1 “was reaching for (their) remote and in (their) own works, (they) fell on (their) Keister, and there was no bumps bruising, no injury POA was notified.” A later Note on 03/01/2026 at 1:45pm indicates “resident was complaining of pain to (their) left side, Resident was transported to St Mary’s Hospital.” LPA received and reviewed Resident R1’s Admission Package the includes a Fall Risk Notice that states “Regency Palms Long Beach can’t always prevent falls and other personal injuries but we will do our best to work with the Residet to identify ways to stay safe.” LPA received and reviewed seven (7) staff training logs on Relias and observed staff have received training regarding Transferring and Proper Positioning. During interviews with Staff S1-S8, were asked if there were any incidents regarding a resident being dropped while providing assistance , eight (8) out of eight (8) stated no, there have been no incidents regarding staff dropping a resident. During interviews with Residents R1-R9, were asked if they have been dropped due to staff neglect during transferring or assistance, nine (9) out of nine (9) stated no, they have not been dropped by staff. Additionally, during an interview Resident R1 stated they were not dropped by staff, and they fell while reaching for their television remote. Allegation: Facility Staff are not keeping accurate records. The allegation alleges that facility staff are not accurately documenting incidents and changes of conditions. During record review, LPA received and reviewed an Unusual Incident/Injury Report that document a fall for R1 on 03/01/2026 at 5:57am, R1 stated they were reaching for their remote and fell out of bed on their back side. The resident was assessed and checked no injuries to report. Residents Power of Attorney was notified, and the resident spoke with them. Additionally, LPA received and reviewed the Notes for Resident R1 from 04/09/2025 through 03/11/2026. LPA observed that on 03/01/2026, the med tech and caregiver who assisted R1 with their fall documented the incident that occurred. LPA observed additional Notes on 03/01/2026, documenting R1 was experiencing left leg pain, and non-emergency transport was arranged to transport R1 to the hospital for an evaluation. The Notes were updated on 03/02/2026 indicating updated from the hospital. LPA received and reviewed the Relias Transcript for seven (7) staff that include training regarding Medication Administration and Documentation. During interviews with staff S1-S8, were asked how staff keep accurate records, eight (8) out of eight (8) stated they keep accurate records by documenting incidents and changes in August Health and in Crossover Notes. During interviews with Residents R1-R9, were asked if they have any concerns regarding staff not keeping accurate records, nine (9) out of nine (9) stated no they have no concerns regarding staff not keeping accurate records. During the course of the investigation, LPA was unable to find evidence to support the allegation(s). Although the allegation(s) may have happened or is valid, there is no preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation(s) are unsubstantiated. An exit interview was conducted with Robert Jakini, Executive Director, and a copy of this report was provided.the state’s words, verbatim · CDSS document, Jul 22, 2026 · control 11-AS-20260309160817

Allegation investigated: Staff hit resident.

On June 15, 2026, the California Department of Social Services/Community Care Licensing (CDSS/CCL) Licensing Program Analyst (LPA), Ernand Dabuet, conducted an initial unannounced complaint visit. Robert Jakini, Executive Director, greeted the LPA. (LPA) explained that the purpose of the visit is to investigate the allegation mentioned above. The investigation, a collection of documents, and a tour of the facility. A review of Personnel Report LIC 500 (dated 06/01/26), Resident Roster (dated 06/11/26), Resident #1 (R1's) Resident Lease Agreement (date10/22/24), Identification and Emergency Information (dated 07/29/25), Physician's Report for for Residential Care Facilities LIC 602A (dated 10/09/24), Service Plan (dated 05/04/26), Personal Rights (dated 10/22/24) Resident Notes & Incidents (dated 05/21/25-04/15/26), Preplacedment Appraisal LIC 603A (dated 10/21/25), Preplacement Appraisal LIC 603A (dated 10/22/24), Incident Report LIC 624 (dated 05/27/26 and other pertinent records associated with this complaint. Interviews conducted with Resident #1-7 and Staff #1-#3. (Evaluation Report continues LIC 9099-C) Unsubstantiated INVESTIGATION REVEALED THE FOLLOWING: Allegation #1: Staff hit resident. It is alleged that staff members physically assaulted Resident #1 (R1). Reports indicate that a female medication technician, who worked between 10 PM and 6 AM, was involved in the incident. The assault resulted in injuries to (R1's) head and shoulder. No further details regarding this matter have been provided. On June 11, 2026, and June 15, 2026, between 01:21 PM and 04:29 PM, the Department interviewed staff members identified as Staff #1 through Staff #3. Three (3) out of the three (3) staff members were not able to corroborate this claim, with each of them denying that any physical assault on Resident #1 (R1) and stating that this allegation is false and misleading. At approximately 10:37 PM on May 26, 2026, staff members (S1-S3) reported that (S2 and S3) responded to a call button alert initiated by (R1). (S2) asked if assistance was needed to reset the call button and inquired about (R1)'s specific needs. (R1) displayed agitation and exhibited physical aggression towards the staff, including actions such as exerting pressure and physical interactions that may be perceived as confrontational. No injuries were reported, and there was no involvement of law enforcement or medical personnel. Neither (S2) nor (S3) had any physical contact with (R1) that resulted in injuries to the head or shoulder. (S1) claimed the incident was reported to Community Care Licensing with an Incident Report LIC 624, Long Term Ombudsman and Report of Suspected Dependent Adult Elder Abuse SOC 341 was completed and filed in reference to this incident. On June 11, 2026, and June 15, 2026, between 11:00 AM and 03:30 PM, the Department interviewed resident members identified as Resident # 1 through Resident #7 (R1-R7). Six (6) out of the seven (7) residents could not support this claim. (R2-R7) affirmed that they have been treated professionally by the staff and have never observed or experienced any physical aggression by them. Each resident expressed a belief that the facility is dedicated to fostering a safe and secure environment for all in care. (R2), who occupies a shared room with (R1), reports that (R2) has not observed any instances of conflict between the staff and (R1), nor has (R2) witnessed any physical altercations. (R1) reported being physically assaulted by a staff member but could not recall the date and time of the incident. During the altercation, (R1) was hit twice in the head and once on the shoulder. (R1) confirmed there were no bruises or marks and did not seek medical treatment. There were no witnesses. The incident was not reported to law enforcement, and (R1) was unable to provide further details. (Evaluation Report continues LIC 9099-C) A review of Personnel Report LIC 500 (dated 06/01/26), Resident Roster (dated 06/11/26), Resident #1 (R1's) Resident Lease Agreement (date10/22/24), Identification and Emergency Information (dated 07/29/25), Physician's Report for Residential Care Facilities LIC 602A (dated 10/09/24), Service Plan (dated 05/04/26), Personal Rights (dated 10/22/24) Resident Notes & Incidents (dated 05/21/25-04/15/26), Preplacement Appraisal LIC 603A (dated 10/21/25), Preplacement Appraisal LIC 603A (dated 10/22/24), Incident Report LIC 624 (dated 05/27/26) and Report of Suspected Dependent Adult/Elder Abuse SOC 341 (dated 06/08/26). An additional review of staff training records verified staff had completed Workplace Sensitivity Training Courses, including ADLs and Behaviors, Psychosocial Needs, Challenging Behaviors, Basic Essentials, Person Center Care and Medication Management. During the visit on June 11, 2026, and June 15, 2026, the Department identified that the facility promotes the rights of its residents. Posters outlining Resident Rights, Personal Rights, and the California Residential Care Facilities for the Elderly Complaint Poster were displayed prominently throughout the facility. The Department also observed no surveillance cameras available in the common areas. Based on the information gathered, there is not enough evidence to support the allegation mentioned above. Based on the information collected from the facility inspection, observations, interviews, and records analysis, the Department found no evidence to support the above allegation. The allegation may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred. Therefore, the allegation is Unsubstantiated. No deficiencies cited. An exit interview was conducted with Robert Jakini, and copies of the reports were provided.the state’s words, verbatim · CDSS document, Jun 15, 2026 · control 11-AS-20260608100401

Allegation investigated: Staff do not ensure that outside vendors are not video recording/taking pictures of residents.

**This report supersedes the report delivered on 04/13/2026 & 04/22/2026 to include additional information to the findings** On 05/22/2026 at 8:45 am, the Department conducted an subsequent visit at this facility to deliver the complaint investigation findings for the allegation 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 04/03/2026 at 2:52pm, the Department requested the following documentation:Staff Roster (received 04/03/2026), Resident Roster (received 04/03/2026), Invoices (dated 10/13/2024, 12/16/2024, 02/14/2025, and 07/28/2025) & Visitor Sign In Sheet (dated January 2026 - April 3, 2026) & conducted interviews on 04/13/2026 with the Administrator (A1), Staff (S1 - S7) & Resident (R1 - R7) between the hours of 9:36am - 3:30pm , (R8, R11) on 04/22/2026 between 12:17pm - 12:41pm, (R9 - R10) on 05/22/2026 between the hours of 10:41am - 12:04pm, & Witness (W1- W3) on 04/22/2026 between 11:55am – 11:59am & 05/21/2026 between 10:41am - 12:04pm. Unsubstantiated The investigation revealed the following: Allegation: Staff do not ensure that outside vendors are not video recording/taking pictures of residents. It was alleged that an outside vendor recorded & photographed residents without consent which was posted online. It was further alleged that facility staff failed to prevent the vendor recordings of the residents. On 04/13/2026 between the hours of 2:40pm - 2:50pm, the department interviewed the Administrator (A1) regarding the allegation. A1 denied the allegation. A1 does not have any knowledge of outside vendors taking photos or videos of residents while on facility premises. A1 mentioned that the facility does not allow any photography unless it is pre-approved and supported by signed releases. A1 reported that outside entities are not permitted to take pictures, and the facility does not allow commercial use of any personal or vendor photography. A1 denied receiving any complaints that a vendor posted resident images or videos online without consent and that no action was taken because the facility had no knowledge of such an event occurring. A1 reported that the facility does request photography consents at move-in; however, even with consents, the facility would never allow commercial use of any photography. On 04/13/2026 between the hours of 9:36am - 12:09pm, the Department interviewed 7 staff (S1–S7) regarding the allegation. 7 out of 7 staff denied the allegation. The staff reported they had never observed an outside vendor taking photos or videos of residents without consent. No complaints from residents nor their families regarding unauthorized recording have been and staff generally understood that recording residents is not allowed and or requires resident/family consent. On 04/13/2026 between 10:45am – 11:47am, on 04/22/2026 between 12:17pm – 12:35pm, and 05/21/2026 between 10:41am – 12:04pm, the Department conducted 11 resident interviews in regards to the allegation. In total, 8 out of 11 residents denied the allegation, 2 out of 11 residents did not confirm nor deny the allegation, and 1 out of 11 residents confirmed the allegation. R1 reported that someone had taken their picture and or video and stated they gave permission but did not provide additional details. R4 reported giving permission for a photo and or video and stated witnessing a visitor making another resident uncomfortable but did not want to elaborate. R9 does not recall seeing any visitors or vendors taking pictures or videos and denied being photographed or recorded. R9 stated no awareness of any recordings or photographs being posted on social media. R9 and R10 did mention that their family member can sign their consent forms. The remaining residents denied being recorded and denied seeing any vendors taking photos or videos, and no resident reported being recorded without consent. On 04/22/2026 between 11:55 AM – 11:59 AM and 05/21/2026 between 9:53am – 10:01am, the Department conducted 3 witness interviews regarding the allegation. All 3 witnesses denied the allegation. W1, who is the Power of Attorney (POA) for R8, reported being aware of the facility’s social media postings and stated that consent for R8 is on file. W2 reported no knowledge of any vendor recording residents and did not report any concerns related to unauthorized photos or videos. W3 reported awareness of content being posted by the facility and did not report any knowledge of a vendor recording residents. No witness reported observing residents being recorded without consent. On 04/13/2026 between 2:15pm - 2:45pm, the Department conducted a records review and observed the following: On the visitor sign in sheet (dated 01/2026 - 04/03/2026), no record of an outside vendor signing in to the facility. According to Media Release Form the resident must indicate the type of approval for photographs and video of the residents/loved ones to be used on the facility bulletin boards, newsletters, and or Facebook page that are sent out to the family members. Check yes if it okay to publish pictures in the newsletter/bulletin board/Facebook page or check NO if you prefer not for your picture to be published in the in the newsletter/bulletin board/Facebook page. Upon the facility reviewing the footage posted on Facebook, four (4) resident were identified. The (4) four residents (Resident 8 (R8) - Resident 11 (R11)) identified in the video footage have media release forms (dated 08/12/2023, 06/12/2024, 08/19/2024, and 04/01/2026) on file which checked yes it is okay to publish pictures in the newsletter/ bulletin board/Facebook page. Overall the facility policies indicate that recording residents requires consent and is otherwise prohibited. Furthermore, the department did not observe an LIC 624: Unusual Incident Report nor any photos and video footage on social media such as YouTube with any of the residents from the facility to support the allegation. On 04/21/2026 between 11:52am – 12:30pm, the Department conducted an additional records review and observed the following: The Department reviewed four invoices dated 10/13/2024, 12/16/2024, 02/14/2025, and 07/28/2025 issued from Regency Palms Long Beach to Pauline Schantzer (DBA Polly Wolly) for comedy show performances. Each invoice reflected a charge of $250.00 for a one hour entertainment event and listed the facility’s Activities Director or Manager as the point of contact. At time of the performances the administrator was Fabiola Mariano. These invoices confirm that performer was contracted by the facility to provide entertainment services on multiple occasions between 2024 and 2025. The Department also reviewed a facility Facebook postdated December 18, 2024, advertising a Comedy Show held at the facility and describing the event as an evening of music, comedy, and resident engagement. On 05/01/2026 between the hours of 2:45pm - 3:00pm, the Department examined R8’s Power of Attorney (POA) for Health Care documentation (dated 10/30/2019). The document identifies W1 as the legally authorized representative for R8 and grants authority to make health-care decisions and provide consent on the resident’s behalf. The POA documentation was current, signed, and valid at the time of review. This information was used to verify that W1 was authorized to speak on behalf of R8 during the interview and to provide consent related information regarding photography, video recording, and awareness of facility social media postings. Another family member sent an email (dated 07/23/2025 at 1:37pm) expressing the joy of the entertainer coming to the facility to perform. Additionally, the Department reviewed a list of social media links such as Tik Tok and Instagram associated with the performer; however, all videos reviewed were not filmed at Regency Palms Long Beach, and none contained identifiable residents or staff from this facility. No documentation was found indicating that the facility authorized or approved the use of resident images for commercial or promotional purposes. Based on information gathered through interviews and record reviews, there is not enough 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 UNSUBSTANTIATED. Exit interview conducted with Robert Jakini (Administrator) and a copy of this report was provided.the state’s words, verbatim · CDSS document, May 21, 2026 · control 11-AS-20260403094602

Type of visit: Case Management - Deficiencies

On 05/20/26, LPA Regina Cloyd conducted an unannounced case management - deficiency visit and met with the Administrator. The purpose of the visit was explained. On 04/30/26, LPA Cloyd conducted an unannounced complaint visit 11-AS-20260424084827. Record review of Residency Agreement reveals three nutritionally well-balanced meals and snacks made available daily, including low salt or other modified diets prescribed by a doctor as a medical necessity, as specified in Title 22, Section 87555, General Food Service Requirement. Review of 2026 S/S Menu Week (04/26/26 - 05/02/26) revealed only breakfast, lunch, and dinner. Interview with the Dining Service Director indicated breakfast is at 7:30 AM, lunch at 12:00 PM, and dinner at 5:00 PM for floors two, three, and four. Breakfast is at 8:00 AM, lunch 12:30 PM, and dinner at 5:30 PM for floors 6 - 8. Snacks are served at 10:00 AM, 2:00 PM, and between 6:30 - 7:00 PM. Four out of four staff interviews (S4 - S7) indicated the facility does not provide snacks to residents in assisted living (floors 6 - 8). Five out of five resident (R1 - R5) that live in assisted living indicated the facility does not provide snacks. According to the California Code of Regulations (Title 22, Division 6, Chapter 8), based on record review and interviews, deficiencies are being cited. Exit interview was held and a copy of the Facility Evaluation Report with Appeal Rights were provided to Administrator Robert Jakini.the state’s words, verbatim · CDSS document, May 20, 2026

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87555(b)(3) · Plan of correction due date: Jun 2, 2026

General Food Service Requirements (b) The following food service requirements shall apply: (3) Between-meal nourishment or snacks shall be made available for all residents unless limited by dietary restrictions prescribed by a physician. This requirement was not met as evidence by: Based on resident and staff interviews, the facility does not provide snacks to its residents in assisted living (floors 6 - 8) which poses a potential health risk to clients in care.the state’s words, verbatim · CDSS document, May 20, 2026

Plan of correction: The Administrator will email a copy of the snack menu and ensure it is posted in assisted living (floors 6-8). POC to be emailed to regina.cloyd@dss.ca.gov by the POC due date.

Allegation investigated: Allegation 1: Staff do not ensure that resident has a sanitary drinking dish

***This report supersedes the original report delivered on 10/31/2025. On 5/7/2026, LPA allen arrived at the facility to deliver the corrected 9099, providing clarification on the original report issued on 10/31/2025. *** On 10/31/2025, 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), Attempted interview with Resident 1(R1) and conducted interviews with Residents 2-7 (R2-R7), and One (1) external witnesses1 (W1). Continued Unsubstantiated The investigation revealed the following Allegation 1: Staff do not ensure that resident has a sanitary drinking dish 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. LPA did observe other residents drinking water or juice from clear cups during the visit. 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 only water in their personal bottles/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 they 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 was able to interview the remaining residents and 6 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, 6 out of 7 residents stated yes. Continued 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. 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.the state’s words, verbatim · CDSS document, May 7, 2026 · control 11-AS-20251024151343

Allegation investigated: Staff denies residents food.

On 04/30/26, Licensing Program Analyst (LPA) Regina Cloyd conducted an initial visit to gather information regarding the above allegation. LPA met with Executive Director Robert Jakini. Investigation consisted of the following: On 04/30/26, the Department obtained Personnel Report, Register of Residents, Food Services documents, One Resident Record, and Two Resident Admission Agreements. LPA interviewed Staff #2 - #8, Residents #1 - #7, and Witnesses #1 - #2. LPA observed lunch in memory care and in assisted living. Investigation revealed the following: Allegation: Staff denies residents food. It is alleged staff does not allow residents to have certain snacks, such as peanut butter and jelly sandwiches, when requested nor additional food servings. Continue to LIC9099-C. Unsubstantiated Record review of daily menu revealed four salad options, four side options, and seven sandwich/wrap//burger options (including peanut butter and jelly sandwiches) are alternative options to the weekly menu. Review of weekly menu revealed breakfast, lunch, and dinner options with the snack selection (not distinguished). Review of lunch and dinner order sheet includes an order column for peanut butter and jelly and other alternative menu selections. Review of admission agreement revealed three nutritionally well-balanced meals and snacks made available daily as specified in Title 22, Section 87555, General Food Service Requirements. Five out of six staff interviews (S2 – S5, S7 – S8) - indicated the daily menu is an alternative to the weekly menu. Six out of seven staff interviews (S2 – S8) indicated residents are allowed to have additional food servings when requested. Seven out of seven staff interviews (S2 – S8) indicated snacks are available to residents in memory care. Six out of six resident interviews (R1 – R5, R7) - indicated they can receive alternatives, including peanut butter and jelly, from the daily menu. R6 assumes alternatives will be provided. Four out of four resident interviews (R1 – R4) indicated they are allowed to have additional food servings when requested. R5 – R7 indicated additional servings has not been requested. One out of two witnesses/responsible parties do not have any complaints about the food services. LPA observed three small snack (fruit) serving trays and peanut butter and jelly supplies in the kitchen. LPA observed residents eating lunch and alternative meals (fish, and sandwich with chips) being served. Regarding the allegation, “Staff denies residents food,” based on record 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.the state’s words, verbatim · CDSS document, Apr 30, 2026 · control 11-AS-20260424084827

Type of visit: Case Management - Other

On 04/23/2026 at 11:35 AM, the Department arrived at the facility to conduct a case management visit related to Complaint Control # 11-AS-20260403094602. Upon arrival, the Department met with Administrator Robert Jakini and explained the purpose of the visit. During today’s visit, the Department requested the following records such as Consent Forms, Admission Agreements, and LIC 602 Physician’s Reports for Residents R8 through R11 as well as conducted interviews with R8 - R11 between the hours of 11:55am - 12:41pm. The Department requested Power of Attorney (POA) documentation be submitted no later than the end of the day tomorrow on 04/23/2026. These documents were collected to further assess Complaint Control # 11-AS-20260403094602. Due to insufficient information available at this time, the case management incidents needs further investigation. An exit interview was conducted with Robert Jakini (Administrator) and copy of this report was provided.the state’s words, verbatim · CDSS document, Apr 23, 2026

Allegation investigated: Staff do not ensure that outside vendors are not video recording/taking pictures of residents

**This report supersedes the report delivered on 04/13/2026 to include additional information to the findings** On 04/22/2026 at 8:30 am, the department conducted an subsequent visit at this facility to deliver the complaint investigation findings for the allegation 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 04/03/2026 at 2:52pm, the Department requested the following documentation Staff Roster (received 04/03/2026), Resident Roster (received 04/03/2026), Invoices (dated 10/13/2024, 12/16/2024, 02/14/2025, and 07/28/2025) and Visitor Sign In Sheet (dated January 2026 - April 3, 2026) and conducted interviews 04/13/2026 with the Administrator (A1), Staff (S1 - S7) & Resident (R1 - R7) between the hours of 9:36am - 3:30pm Report continues on LIC 9099-C Unsubstantiated The investigation revealed the following: Allegation: Staff do not ensure that outside vendors are not video recording/taking pictures of residents. It was alleged that an outside vendor recorded & photographed residents without consent which was posted online. It was further alleged that facility staff failed to prevent the vendor recordings of the residents. On 04/13/2026 between the hours of 2:40pm - 2:50pm, the department interviewed the Administrator (A1) regarding the allegation. A1 denied the allegation. A1 does not have any knowledge of outside vendors taking photos or videos of residents while on facility premises. A1 mentioned that the facility does not allow any photography unless it is pre-approved and supported by signed releases. A1 reported that outside entities are not permitted to take pictures, and the facility does not allow commercial use of any personal or vendor photography. A1 denied receiving any complaints that a vendor posted resident images or videos online without consent and that no action was taken because the facility had no knowledge of such an event occurring. A1 reported that the facility does request photography consents at move-in; however, even with consents, the facility would never allow commercial use of any photography. On 4/13/2026 between the hours of 9:36am - 12:09pm, the Department interviewed 7 staff (S1–S7) regarding the allegation. 7 out of 7 staff denied the allegation. The staff reported they had never observed an outside vendor taking photos or videos of residents without consent. No complaints from residents nor their families regarding unauthorized recording have been and staff generally understood that recording residents is not allowed and or requires resident/family consent. On 04/13/2026 between the hours of 10:45am - 11:47am, the Department interviewed 7 residents (R1–R7) regarding the allegation. 5 out of 7 residents denied the allegation. 2 of 7 resident did not confirm nor deny the allegation. All 7 residents were unaware of any situation involving a vendor recording residents. R1 reported that someone had taken their picture/video and stated they gave permission but did not provide additional details. R4 reported giving permission for a photo/video and stated a witnessing a visitor making another resident uncomfortable but did not want to elaborate. The remaining residents denied being recorded and denied seeing any vendors taking photos or videos. No resident reported being recorded without consent. Report continues on LIC 9099-C On 04/13/2026 between 2:15pm - 2:45pm, the Department conducted a records review and observed the following: On the visitor sign in sheet (dated 01/2026 - 04/03/2026), no record of an outside vendor signing in to the facility. According to Media Release Form the resident must indicate the type of approval for photographs and video of the residents/loved ones to be used on the facility bulletin boards, newsletters, and or Facebook page that are sent out to the family members. Check yes if it okay to publish pictures in the newsletter/bulletin board/Facebook page or check NO if you prefer not for your picture to be published in the in the newsletter/bulletin board/Facebook page. Overall the facility policies indicate that recording residents requires consent and is otherwise prohibited. Furthermore, the department did not observe an LIC 624: Unusual Incident Report nor any photos and video footage on social media such as Youtube with any of the residents from the facility to support the allegation. On 04/21/2026 between 11:52am – 12:30pm, the Department conducted an additional records review and observed the following: The Department reviewed four invoices dated 10/13/2024, 12/16/2024, 02/14/2025, and 07/28/2025 issued from Regency Palms Long Beach to Pauline Schantzer (DBA Polly Wolly) for comedy show performances. Each invoice reflected a charge of $250.00 for a one hour entertainment event and listed the facility’s Activities Director or Manager as the point of contact. At time of the performances the administrator was Fabiola Mariano. These invoices confirm that performer was contracted by the facility to provide entertainment services on multiple occasions between 2024 and 2025. The Department also reviewed a facility Facebook post dated December 18, 2024, advertising a Comedy Show held at the facility and describing the event as an evening of music, comedy, and resident engagement. Upon the facility reviewing the footage posted on facebook, four (4) resident were identified. The (4) four residents identified in the video footage have media release forms (dated 08/12/2023, 06/12/2024, 08/19/2024, and 04/01/2026) on file which checked yes it is okay to publish pictures in the newsletter/ bulletin board/Facebook page. Another family member sent an email (dated 07/23/2025 at 1:37pm) expressing the joy of the entertainer coming to the facility to perform. Additionally, the Department reviewed a list of social media links such as Tik Tok and Instagram associated with the performer; however, all videos reviewed were not filmed at Regency Palms Long Beach, and none contained identifiable residents or staff from this facility. No documentation was found indicating that the facility authorized or approved the use of resident images for commercial or promotional purposes. Report continues on LIC 9099-C Based on information gathered through interviews and record reviews, there is not enough 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 UNSUBSTANTIATED. Exit interview conducted with Robert Jakini (Administrator) and a copy of this report was provided.the state’s words, verbatim · CDSS document, Apr 22, 2026 · control 11-AS-20260403094602

Allegation investigated: 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.

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 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 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 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 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 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 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.the state’s words, verbatim · CDSS document, Apr 22, 2026 · control 11-AS-20260406104835

Allegation investigated: Facility staff did not seek timely medical attention for resident

**The report supersedes the delivered reported on 04/13/2026 to include additional information to the findings** On 04/22/2026 at 8:30 am, the department conducted an subsequent visit at this facility to deliver the complaint investigation findings for the allegation 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 03/11/2026 at 8:45am the department conducted interviews with Administrator (A1), Staff (S1-S6) & Residents (R2- R11), between the hours of 8:45am - 3:06pm and with R1 on 03/12/2026 between the hours 1045am -11:10am. The department also requested the following documentation: Staff Roster (received 03/11/2026), Resident Roster (received 03/11/2026) , Resident 1's (R1), records such as Admission Agreement (dated 12/2024) LIC 601: Identification & Emergency Information (dated 12/20/2024) . . . Report continues on LIC 9099-C Unsubstantiated LIC 602: Physician Report for Residential Care Facilities for the Elderly (RCFE) (dated 08/01/2025) , , LIC 621 Resident Personal Property & Valuables (dated 12/20/2024) LIC 613 Personal Rights (dated 12/20/2024) Resident Assessment (dated 12/31/2025), Service Plan (dated 07/29/2025), Medication Administration Record (January - March 2026), Communication Logs (dated 03/01/2026 & 03/03/2025. Alert Report for Care Predict (03/01/2026), Staff Schedule (dated 02/22/2026 - 03/07/2026) and Notice of Employee as to Change in Relationship (03/05/2026). The investigation revealed the following: Allegation: Facility staff did not seek timely medical attention for resident. It was alleged that facility staff did not obtain urgent medical assistance for a resident after the resident experienced a fall and later reported feeling ill with numbness on one side of the body. It was further alleged that staff delayed contacting emergency services and instead arranged non-emergency transport several hours after the resident’s symptoms were reported. The resident was subsequently transported to a hospital, where diagnostic testing determined the resident had suffered a stroke On 03/11/2026 between the hours of 10:52am - 11:49am, the Department conducted an interview with the Administrator (A1) regarding the allegation. A1 denied the allegation. A1 stated the resident showed no signs of injury after the fall and initially denied pain. A1 reported that later in the morning the resident complained of soreness on the left side, and the Medtech on duty contacted non-emergency medical transport because the resident did not appear to be in immediate distress. A1 explained that staff made this decision rather than wait for the R1's family member who was called multiple times and did not answer to transport the resident, as staff had previously received pushback from the fire department for calling 911 for situations they considered non-emergencies. A1 stated that staff were instructed that moving forward, 911 should be contacted when a resident shows any concerning symptoms, and if the fire department has concerns, they are to contact the Administrator directly. A1 reported that staff assessed the resident, notified the resident power of attorney, and arranged transport consistent with their understanding of protocol at the time. Report continues on LIC 9099-C On 03/11/2026 between the hours of 8:45am - 3:06pm, the Department conducted six (6) staff (S1–S6) interviews regarding the allegation. 4 of 6 staff denied the allegation. 2 of 6 staff were aware of the incident but did not confirm nor deny the allegation. Staff reported that the resident fell during the overnight shift, initially with resident denying pain, and appeared stable. Staff stated that the next day in the morning the resident reported left-side discomfort, and initial contacted non-emergency dispatch and Premier transport was contacted. Some staff reported attempts to contact the resident family member multiples times, while other staff stated that 911 was not called immediately after the fall because the resident initially felt no pain. Staff described following internal communication procedures and notifying supervisors. On 03/11/2026 between the hours 11:20am - 11:47am and 03/12/2026 between the hours of 10:45am - 11:10am, the department conducted 11 resident interviews. 11 of 11 residents denied the allegation. Residents generally reported that staff respond to their needs in a timely manner, feel safe in the facility, and did not report concerns about delays in medical care. One resident who experienced the incident stated staff assisted and medical help was obtained, though transport which took time. The residents had no knowledge of the incident or reported no issues with staff responsiveness. On 04/10/2026, between 2:32 pm - 4:00pm, the Department conducted a record review and observed the following: on 03/01/2026 at 3:39 am, the facility’s wearable monitoring system detected a fall involving the resident. According to incident notes created on 03/03/2026, the resident reported falling while reaching for a remote and landing on their buttocks, which was also documented in a facility group text message at 5:53am on the same date. The notes further indicated that at 10:24 am, the resident reported difficulty moving the left side of their body, and non-emergency medical transport was contacted for evaluation. Staff documented multiple attempts to contact the resident’s responsible party at 5:36 am, 11:30 am, and 11:41 am, with voicemail inbox full, and a text message was sent notifying the responsible party that the resident was being transported for evaluation. Staff documented that the resident was assessed with no visible injuries such as bumps or bruising. Records also showed that the resident later complained of left-side pain at 1:45 p.m. and was transported to the hospital. A progress note dated 03/02/2026 at 1:57pm indicated that the hospital initially reported no stroke on CT scan, but an MRI later confirmed a stroke. Report continues on LIC 9099-C Hospital records from 03/01/2026 - 03/05/2026 documented that the resident was admitted with left-sided weakness. A CT scan initially showed no acute findings. An MRI performed on 03/01/2026 revealed an “acute/recent patchy infarct in the posterior right frontal lobe/precentral gyrus,” confirming an acute ischemic stroke. The resident remained hospitalized through 03/05/2026, receiving dual anti platelet therapy, statin therapy, neurological monitoring, and rehabilitative services. Upon further review, according to the National Institutes of Health (NIH), common symptoms of an acute stroke include sudden weakness or numbness on one side of the body, difficulty speaking, facial drooping, or loss of coordination, which are consistent with the left sided weakness documented in the hospital record. Based on information gathered through interviews and record reviews, there is not enough evidence to support allegation that staff knowingly delayed emergency medical care or failed to respond when symptoms were reported. 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.the state’s words, verbatim · CDSS document, Apr 22, 2026 · control 11-AS-20260303091726

Allegation investigated: Staff do not ensure that outside vendors are not video recording/taking pictures of residents.

On 04/13/2026 at 9:10 am, the department conducted an subsequent visit at this facility to deliver the complaint investigation findings for the allegation 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 04/03/2026 at 2:52pm, the Department requested the following documentation Staff Roster (received 04/03/2026), Resident Roster (received 04/03/2026) and Visitor Sign In Sheet (dated January 2026 - April 3, 2026) and conducted interviews o 04/13/2026 with the Administrator (A1), Staff (S1 - S7) & Resident (R1 - R7) between the hours of 9:36am - 3:30pm The investigation revealed the following: Allegation: Staff do not ensure that outside vendors are not video recording/taking pictures of residents. It was alleged that an outside vendor recorded & photographed residents without consent which was posted online. It was further alleged that facility staff failed to prevent the vendor recordings of the residents. Unsubstantiated On 04/13/2026 between the hours of 2:40pm - 2:50pm, the department interviewed the Administrator (A1) regarding the allegation. A1 denied the allegation. A1 does not have any knowledge of outside vendors taking photos or videos of residents while on facility premises. A1 mentioned that the facility does not allow any photography unless it is pre-approved and supported by signed releases. A1 reported that outside entities are not permitted to take pictures, and the facility does not allow commercial use of any personal or vendor photography. A1 denied receiving any complaints that a vendor posted resident images or videos online without consent and that no action was taken because the facility had no knowledge of such an event occurring. A1 reported that the facility does request photography consents at move-in; however, even with consents, the facility would never allow commercial use of any photography. On 4/13/2026 between the hours of 9:36am - 12:09pm, the Department interviewed 7 staff (S1–S7) regarding the allegation. 7 out of 7 staff denied the allegation. The staff reported they had never observed an outside vendor taking photos or videos of residents without consent. No complaints from residents nor their families regarding unauthorized recording have been and staff generally understood that recording residents is not allowed and or requires resident/family consent. On 04/13/2026 between the hours of 10:45am - 11:47am, the Department interviewed 7 residents (R1–R7) regarding the allegation. 5 out of 7 residents denied the allegation. 2 of 7 resident did not confirm nor deny the allegation. All 7 residents were unaware of any situation involving a vendor recording residents. R1 reported that someone had taken their picture/video and stated they gave permission but did not provide additional details. R4 reported giving permission for a photo/video and stated a witnessing a visitor making another resident uncomfortable but did not want to elaborate. The remaining residents denied being recorded and denied seeing any vendors taking photos or videos. No resident reported being recorded without consent. On 04/13/2026 between 2:15pm - 2:45pm, the Department conducted a records review and observed the following: On the visitor sign in sheet (dated 01/2026 - 04/03/2026), no record of an outside vendor signing in to the facility.According to Media Release Form the resident must indicate the type of approval for photographs and video of the residents/loved ones to be used on the facility bulletin boards, newsletters, and or Facebook page that are sent out to our family member. Check yes if it okay to publish pictures in the newsletter/bulletin board/Facebook page or check NO if you prefer not for your picture to be published in the in the newsletter/bulletin board/Facebook page. Overall the facility policies indicate that recording residents requires consent and is otherwise prohibited. Furthermore, the department did not observe an LIC 624: Unusual Incident Report nor any photos and video footage on social media such as Youtube with any of the residents from the facility to support the allegation. Based on information gathered through interviews and record reviews, there is not enough 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 UNSUBSTANTIATED. Exit interview conducted with Robert Jakini (Administrator) and a copy of this report was provided.the state’s words, verbatim · CDSS document, Apr 13, 2026 · control 11-AS-20260403094602

Allegation investigated: Facility staff did not seek timely medical attention for resident

On 04/13/2026 at 9:10am, the department conducted an subsequent visit at this 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. On 03/11/2026 at 8:30am, Licensing Program Analyst (LPA) Zina Brown conducted an initial visit at this facility to deliver the complaint investigation findings for the allegations above. During today’s visit, LPA met with Robert Jakini (Administrator) and explained the purpose of the visit. The investigation consisted of the following: On 03/11/2026 at 8:45am the department conducted interviews with Administrator (A1), Staff (S1-S6) & Residents (R2- R11), between the hours of 8:45am - 3:06pm and with R1 on 03/12/2026 between the hours 1045am -11:10am. The department also requested the following documentation: Staff Roster (received 03/11/2026), Resident Roster (received 03/11/2026) , Resident 1's (R1), records such as Admission Agreement (dated 12/2024) LIC 601: Identification & Emergency Information (dated 12/20/2024), LIC 602: Physician Report for Residential Care Facilities for the Elderly (RCFE) (dated 08/01/2025), LIC 621 Resident Personal Property & Valuables (dated 12/20/2024) LIC 613 Personal Rights (dated 12/20/2024) Resident Assessment (dated 12/31/2025), Service Plan (dated 07/29/2025), Medication Administration Record (January - March 2026), Communication Logs (dated 03/01/2026 & 03/03/2025. Alert Report for Care Predict (03/01/2026), Staff Schedule (dated 02/22/2026 - 03/07/2026) and Notice of Employee as to Change in Relationship (03/05/2026). Unsubstantiated The investigation revealed the following Allegation: Facility staff did not seek timely medical attention for resident. It was alleged that facility staff did not obtain urgent medical assistance for a resident after the resident experienced a fall and later reported feeling ill with numbness on one side of the body. It was further alleged that staff delayed contacting emergency services and instead arranged non-emergency transport several hours after the resident’s symptoms were reported. The resident was subsequently transported to a hospital, where diagnostic testing determined the resident had suffered a stroke On 03/11/2026 between the hours of 10:52am - 11:49am, the Department conducted an interview with the Administrator (A1) regarding the allegation. A1 denied the allegation. A1 stated the resident showed no signs of injury after the fall and initially denied pain. A1 reported that later in the morning the resident complained of soreness on the left side, and the Medtech on duty contacted non-emergency medical transport because the resident did not appear to be in immediate distress. A1 explained that staff made this decision rather than wait for the R1's family member who was called multiple times and did not answer to transport the resident, as staff had previously received pushback from the fire department for calling 911 for situations they considered non-emergencies. A1 stated that staff were instructed that moving forward, 911 should be contacted when a resident shows any concerning symptoms, and if the fire department has concerns, they are to contact the Administrator directly. A1 reported that staff assessed the resident, notified the resident power of attorney, and arranged transport consistent with their understanding of protocol at the time. On 03/11/2026 between the hours of 8:45am - 3:06pm, the Department conducted six (6) staff (S1–S6) interviews regarding the allegation. 4 of 6 staff denied the allegation. 2 of 6 staff were aware of the incident but did not confirm nor deny the allegation. Staff reported that the resident fell during the overnight shift, initially with resident denying pain, and appeared stable. Staff stated that the next day in the morning the resident reported left-side discomfort, and initial contacted non-emergency dispatch and Premier transport was contacted. Some staff reported attempts to contact the resident family member multiples times, while other staff stated that 911 was not called immediately after the fall because the resident initially felt no pain. Staff described following internal communication procedures and notifying supervisors. On 03/11/2026 between the hours 11:20am - 11:47am and 03/12/2026 between the hours of 10:45am - 11:10am, the department conducted 11 resident interviews. 11 of 11 residents denied the allegation. Residents generally reported that staff respond to their needs in a timely manner, feel safe in the facility, and did not report concerns about delays in medical care. One resident who experienced the incident stated staff assisted and medical help was obtained, though transport which took time. The residents had no knowledge of the incident or reported no issues with staff responsiveness. Report continues on LIC 9099-C On 04/10/2026, between 2:32 pm - 4:00pm, the Department conducted a record review and observed the following: on 03/01/2026 at 3:39 am, the facility’s wearable monitoring system detected a fall involving the resident. According to incident notes created on 03/03/2026, the resident reported falling while reaching for a remote and landing on their buttocks, which was also documented in a facility group text message at 5:53am on the same date. The notes further indicated that at 10:24 am, the resident reported difficulty moving the left side of their body, and non-emergency medical transport was contacted for evaluation. Staff documented multiple attempts to contact the resident’s responsible party at 5:36 am, 11:30 am, and 11:41 am, with voicemail inbox full, and a text message was sent notifying the responsible party that the resident was being transported for evaluation. Staff documented that the resident was assessed with no visible injuries such as bumps or bruising. Records also showed that the resident later complained of left-side pain at 1:45 p.m. and was transported to the hospital. A progress note dated 03/02/2026 at 1:57pm indicated that the hospital initially reported no stroke on CT scan, but an MRI later confirmed a stroke. Hospital records from 03/01/2026 - 03/05/2026 documented that the resident was admitted with left-sided weakness. A CT scan initially showed no acute findings. An MRI performed on 03/01/2026 revealed an “acute/recent patchy infarct in the posterior right frontal lobe/precentral gyrus,” confirming an acute ischemic stroke. The resident remained hospitalized through 03/05/2026, receiving dual antiplatelet therapy, statin therapy, neurological monitoring, and rehabilitative services. Unsubstantiated: Based on information gathered through interviews and record reviews, there is not enough 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 UNSUBSTANTIATED. Exit interview conducted with Robert Jakini (Administrator) and a copy of this report was provided.the state’s words, verbatim · CDSS document, Apr 13, 2026 · control 11-AS-20260303091726

Allegation investigated: Staff did not adequately address a change in resident’s condition.

On 04/03/2026 at 12:40pm, the department conducted an subsequent visit at this facility to deliver the complaint investigation findings for the allegation 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 03/24/2026 at 8:45am the department conducted interviews with Administrator (A1), Staff (S1-S3) & Residents (R1- R10), between the hours of 9:25am - 11:43am and requested the following documentation: Staff Roster (received 03/24/2026), Resident Roster (received 03/24/2026), Staff Schedule (dated 03/15/2026 - 03/21/2025 Resident 1's (R1), records such as Admission Agreement (dated 02/19/2024) LIC 601: Identification & Emergency Information (dated 02/18/2024), LIC 602: Physician Report for Residential Care Facilities for the Elderly (RCFE) (dated 04/23/2025), LIC 603: Preplacement Appraisal Information (dated 02/20/2024), Service Plan (dated 07/29/2025), Medication Administration Record (January - March 2026), Communication Logs (dated 10/2025), Certificate of Acknowledge of Notary Public (dated 04/20/2023), LIC 624 Unusual Incident/Injury Report (dated 01/05/2026 & 02/27/2026), Regency Palms Senior Living Standard Operating Procedures (revision date 01/01/2026) and Email Correspondent (dated 03/20/2026). Unsubstantiated The investigation revealed the following: Allegation: Staff did not adequately address a change in resident’s condition. It was alleged the resident had not been acting like themselves for several days and that the resident's urine had a strong, unpleasant odor, which are symptoms consistent with a urinary tract infection. It was further alleged that facility staff failed to notify the resident's healthcare provider of the observed changes in condition, despite the healthcare provider being the resident's primary care coordinator. On 03/24/2026 between the hours of 10:20am - 10:30am, the department interview the Administrator (A1) in regards to the allegation.A1 denied the allegation. A1 stated the facility had no prior knowledge of any change in the resident's condition before 03/20/2026, as the resident was at her normal baseline and did not present with any symptoms of concern. A1 mentioned on the evening of 03/19/2026, the resident's family informed a MedTech that the resident had a UTI and would take the resident for evaluation. A1 stated the facility was not aware of a confirmed diagnosis until after the resident was seen by Welbe Health and that the family had already contacted Welbe directly. A1 stated the facility's protocol for a suspected UTI is to request a urinalysis from the appropriate medical professionals and follow all guidance provided, including medication administration. On 03/24/2026 between the hours of 9:25am -10:18am, the department interview 3 staff in regards to the allegation. 3 out of 3 staff denied the allegation. Staff stated they did not observe or receive notification of any change in the resident's condition prior to 03/20/2026 and that Welbe Health was not notified because no change in condition had been identified. Staff stated the facility's protocol when a change in condition or suspected UTI is identified is to report to the MedTech, who is then responsible for notifying the healthcare provider. On 03/24/2026 between the hours of 10:36am - 11:43am, the department 10 residents in regards to the allegation 1 out of 10 residents confirmed having a UTI but was unable to confirm how the facility staff addressed this situation. R1 recalled not feeling like themselves and noticing changes around 03/20/2026, and understands that their family member is the POA. 8 out of 10 Residents denied the allegation and stated staff respond to their medical needs in a timely manner. 1 out of 10 Residents did not confirm nor deny the allegation and stated staff do not respond to medical needs in a timely manner and that there has been a time when a request for medical help was not followed through. On 04/02/2026, between the hours of 9:45am – 1:54pm, the department corresponded with Witness 1 (W1) in regards to the allegation.W1 confirmed the allegation. W1 stated that behavioral changes were first observed on 03/18/2026 by R1's private caregiver and that facility staff were notified of concerns regarding a possible UTI on 03/19/2026. W1 stated the facility took no action, did not notify Welbe Health, and that the family themselves transported the resident to Welbe Health on 03/20/2026, where the resident tested positive for a UTI. Report continues on LIC 9099-C On 04/02/2026 between the hours 2:50pm - 3:45pm, the department conducted a records review and observed the following: For R1's LIC 602A (dated 04/23/2025) indicated the resident has bladder impairment and is incontinent. For R1's LIC 603A (dated 02/20/2024) noted moderate bladder impairment with incontinence and indicated the resident needs assistance with toileting and incontinence care. R1's Service Plan (dated 07/29/2025) indicated the resident requires reminders, verbal cues, and assistance with incontinence care in the AM, PM, and nighttime, with a toileting schedule to be followed by female staff only. The Regency Palms Senior Living Standard Operating Procedures (revision date 01/01/2026), under the Significant Change of Condition Policy, requires the facility to promptly identify, report, evaluate, and address any significant change in a resident's physical, cognitive, or behavioral condition and to coordinate with the resident, responsible party, and medical providers. The policy notes that a significant change is not an established, predictive, cyclic pattern such as frequent urinary tract infections. The Medication Administrator Record (MAR) for March 2026 shows R1 was prescribed Nitrofurantoin Mono-MCR 100 MG (as of 03/23/2026) to be taken twice for five (5) days with the stop date on March 28, 2026. Per the MAR it is documented that R1 was administered the Nitrofurantoin Mono-MCR 100 MG from March 23, 2026 - March 28, 2026. Unsubstantiated: Based on information gathered through interviews and record reviews, there is not enough 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 UNSUBSTANTIATED. Exit interview conducted with Robert Jakini (Administrator) and a copy of this report was providedthe state’s words, verbatim · CDSS document, Apr 3, 2026 · control 11-AS-20260322123019

Allegation investigated: Staff does not ensure residents receive correspondence in a prompt manner.

On March 17, 2026, Licensing Program Analyst (LPA) Pamela Bunker conducted an initial visit to gather information regarding the above allegations. LPA met with Robert Jakini, Executive Director, and explained the purpose of the visit. LPA was granted entry to the facility. The investigation consisted of the following: On March 17, 2026, the following documents were reviewed and obtained as part of the investigation: Personnel Report (dated 03/17/2026), Resident Roster (dated 03/17/2026), Uniform Statutory Form Power of Attorney (dated 04/20/2023), and Admission Agreement (dated 02/16/2024). In addition, on March 17, 2027, between 10:25 a.m. and 2:30 p.m., LPA Bunker conducted interviews with staff members S#1–S#3 (S1-S3) and residents R#1–R#5 (R1-R5) regarding the above complaint allegation. LPA Bunker and Mr. Jakini observed the facility’s mail station and reviewed the current procedures for receiving, sorting, and distributing resident mail to assess whether the established process is being followed consistently. See continued LIC9099-C page 2. Unsubstantiated Continued LIC9099-C page 2. Investigation revealed the following: Allegation: Staff does not ensure residents receive correspondence in a prompt manner. It was alleged that staff fail to ensure residents receive their mail in a prompt manner. On 03/17/2026, between 10:25 a.m. and 2:30 p.m., LPA Bunker interviewed staff members S1–S3. All 3 out of 3 staff members stated that the facility ensures residents receive their correspondence in a timely manner. 3 out of 3 staff members explained that when mail is delivered by the mail carrier, it is immediately sorted, separated by floors, and distributed to residents in the Assisted Living Unit (ALU) by the end of the day. 3 out of 3 staff members stated that mail for residents in the Memory Care Unit (MCU) is held at the front desk in a locked, sorted cabinet. This process is in place because residents in the MCU have dementia and are unable to manage or keep track of their mail. According to S1–S3, mail for MCU residents is released only to responsible parties, family members, or the Power of Attorney (POA) upon request. Staff emphasized that they do not provide resident mail to anyone who is not the designated responsible party. 3 out of 3 staff members reported that the resident’s mail in question had accumulated for approximately four months because the POA was not picking up the mail, despite staff’s attempts to contact the POA. Staff stated that the mail continued to pile up and that family members frequently came in on weekends after hours requesting the mail, which could not be released at those times because it was secured. S1 stated that they reached out to the POA and offered either to mail the resident’s correspondence directly to them or to arrange a specific time for the mail to be picked up from the facility. All three staff members confirmed that the facility has established procedures to ensure residents receive their correspondence in a timely manner and denied the allegation. During today's visit, LPA Bunker also observed staff actively distributing mail to residents. On 03/17/2026, between 10:25 a.m. and 2:30 p.m., LPA Bunker conducted interviews with residents R1–R5. 5 out of 5 residents stated that staff ensure they receive their mail in a prompt and timely manner and reported no issues with receiving their correspondence when it is delivered by the mail carrier. Three out of three residents interviewed regarding this allegation denied that staff fail to provide mail in a timely manner. See continued LIC9099-C page 2. Continued LIC9099-C page 3. 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. There were no deficiencies cited. A copy of the Complaint Investigation Report LIC9099 and LIC9099-Cs was provided to Robert Jakini, Executive Director. An exit interview was conducted.the state’s words, verbatim · CDSS document, Mar 17, 2026 · control 11-AS-20251107090154

Allegation investigated: Staff did not notify resident's responsible party of a change in resident's condition.

On March 12, 2026, the California Department of Social Services/Community Care Licensing (CDSS/CCL) Licensing Program Analyst (LPA) Ernand Dabuet conducted an initial unannounced complaint visit. Robert Janiki Executive Director greeted the LPA. LPA explained that the purpose of the visit is to investigate the allegation mentioned above. The investigation included a collection of records, interviews and collateral visit to Bixby Towers Post Acute Rehab. The Department collected service records for Resident #1 (R1), Medical Assessment for Residential Care Facilities for the Elderly LIC 602A (dated 08/01/25), Identification and Emergency Information LIC 601 (dated 12/20/24), Resident Assessment (dated 12/31/25), Unusual Incident Report LIC 624 (dated 03/03/26), and Durable Power of Attorney for Management of Property and Personal Affairs (dated 06/15/24) for and other documents pertinent or associated with this complaint. Interviews conducted with Resident #1 and Staff #1-#4 and Witness #1. (Evaluation Report continues LIC 9099--C) Unsubstantiated INVESTIGATION REVEALED THE FOLLOWING: Allegation: Staff did not notify resident's responsible party of a change in resident's condition. It is alleged that the facility failed to notify the party responsible of Resident #1 (R1) regarding a change in the resident’s condition. Reports indicate that (R1) began exhibiting symptoms of a stroke on Saturday, February 28, 2026, yet the facility did not inform the responsible party. While it is unclear whether (R1) had a stroke on February 28, 2026, there was a noticeable change in condition, and no responsible party was notified. The following day, March 1, 2026, (R1) fell; however, the party responsible was not informed of the severity of the fall. The reports indicate that the fall occurred when (R1) reached for a television remote. No additional information has been provided regarding this incident. On March 12, 2026, between 10:45 AM and 11:10 AM, the Department interviewed a resident member identified as Resident #1. (R1) remembered feeling unwell on February 28, 2026, and then experiencing a fall. R1 said that (R1) didn't know exactly how (R1) felt but was sure (R1) did not feel well. After going to the hospital, doctors diagnosed (R1) with a mild stroke based on an MRI scan, which showed it affected the left side of (R1's) body. (R1) explained that when (R1) felt unwell, the facility staff responded immediately and called for medical assistance; however, Emergency Medical Services (EMS) did not arrive promptly. During the interview, (R1) confirmed that the person responsible for (R1) was informed about (R1's) health change. (R1) also said this person was allowed to talk with (R1). (R1) described the fall as happening when (R1) reached for the television remote, lost balance, and slipped. (R1) agreed to go to the hospital for treatment. Overall, R1 reported that the facility staff treated (R1) well, responded quickly to (R1's) needs, and always provided (R1) with medical help. On March 12, 2026, between 11:30 AM and 1:00 PM, the Department interviewed staff members identified as Staff #1 through Staff #4 (S1-S4). Three (3) out of the four (4) staff members could not corroborate this claim. All staff members confirmed that the family representative was notified. They explained that on the evening of February 28, 2026, the resident (R1) did not feel well, but staff did not consider it a significant change in the resident's condition as (R1) was fine the day before. (Evaluation Report continues) Staff members (S2-S4) stated they are not trained medical professionals and indicated they could not determine if (R1) was experiencing a stroke. This was only verified after (R1) was hospitalized and had a (MRI). Prior to the (MRI) the hospital contacted the facility and made the medical assessment that (R1) did not have a stroke. Even the hospital was uncertain. During the assessment at the facility, (R1) reported feeling unwell but did not want to request medical attention. The following morning, (R1) experienced a fall and even then (R1) refused medical attention Staff assisted (R1), who claimed to have no injuries that would require calling 9-1-1. During this time, facility staff attempted to contact the family representative several times by phone and text, but there was no response. (S2-S4) explained that the proper procedure for care staff is to notify the medication technician if they observe a change in a resident's condition, who will then report to the Wellness Nurse. However, (S2-S4) clarified that the facility took proactive measures by contacting 9-1-1 after (R1) fell, and non-emergency paramedics and EMTs determined that the situation was non-emergency. The Department reviewed Resident #1 (R1’s) Medical Assessment for Residential Care Facilities for the Elderly LIC 602A (dated 08/01/25), Identification and Emergency Information LIC 601 (dated 12/20/24), Resident Assessment (dated 12/31/25), Unusual Incident Report LIC 624 (dated 03/03/26), St. Mary’s Hospital Medical Records, Email Communications (dated 03/06/26) and Durable Power of Attorney for Management of Property and Personal Affairs (dated 06/15/24). Further review of Communication Logs (dated 03/01/2026 & 03/03/2025), Alert Report for Care Predict (03/01/2026), Staff Schedule (dated 02/22/2026 - 03/07/2026) and Notice of Employee as to Change in Relationship (03/05/2026) verified that (R1’s) was notified multiple times on March 1, 2026, between 05:27 AM and 11:41 AM with phone calls and messages. The Community Care Licensing Unusual Incident Report LIC 624 revealed the family representative was notified. Based on the information gathered, there is not enough evidence to support the allegation mentioned above. Based on the information gathered from the facility, observations, interviews, and records analysis, the Department found no evidence to support the above allegation. The allegation may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred. Therefore, the allegation is Unsubstantiated. An exit interview was conducted with Robert Jakini, and copies of the reports were provided.the state’s words, verbatim · CDSS document, Mar 12, 2026 · control 11-AS-20260305124925

Allegation investigated: Staff falsifield a resident's records while in care. Staff mishandled a resident's medications while in care.

On 02/13/26, Licensing Program Analyst (LPA) Antonine Richard conducted a subsequent visit to deliver findings regarding the above-mentioned allegations. The department met with Executive Director Jakini Robert and explained the purpose of the visit. The Investigation consisted of the following: On 05/21/25, the department requested and obtained the following documents via email: Copy of the staff and resident roster, reviewed residents files and collected copies of a Resident #1 (R1) Lease Agreement, Service Plan, Resident Assessment, Preplacement Appraisal Information, Identification and Emergency Information, Physician’s Report, Medication Destruction Records, Resident Care Plan, Unusual Incident Report/Resident Medical Records, Staff notes, Doctor visit reports, Doctors orders, Hospital discharge papers for (R1). The Department interviewed 3 staff members (S1-S3), the Executive Director (ED), the Medical Physician (MP), and six Residents #1-6 (R1-R6). Report Continued on LIC9099C Substantiated Allegation #2: Staff falsified a resident's records while the resident was in care. Regarding the allegation, “Staff falsified a resident's records while in care,” The complaint alleged that staff are initialing medications they do not have or that have been discontinued. During the department visit on 11/12/25, the department interviewed six residents, #1-6 (R1-R6), who denied the allegations. The department also interviewed three staff members, #1-3 (S1-S3). Two of the three staff members stated they mishandled R1’s medication while in care. The department reviewed the QuikMAR system and the medications for Resident #1 (R1). It was noted that two medications for R1 were marked as administered; however, one medication, Fluoxetine HCl 10 mg capsule, had been discontinued on July 7, 2024, but still appeared as administered in May 2025. Additionally, a new prescription for Fluoxetine HCl 40 mg capsule was issued on July 7, 2024, but it was also discontinued in May 2025. The Department reviewed QuikMAR for Resident #1 and found the documentation for medication administration insufficient. Medications intended for oral administration as a single tablet every 12 hours were not accurately recorded. Med Tech did not initiate some entries; some medications were not documented when they were refused or when residents were out of the community; and others should not have been initiated for various reasons. Additionally, these medications should not be included on the list for administration by Med Tech for Resident #1 (R1). Regarding the allegation, “Staff falsified a resident's records while in care,” based on record reviews, the preponderance of evidence standard has been met, therefore the above allegation(s) is found to be substantiated. The California Code of Regulations (Title 22, Division 6 & Chapter 8) is cited in the attached LIC 9099D. A civil penalty was assessed for a repeat violation within the last 12 months. Allegation: #3: Staff mishandled a resident's medications while in care Regarding the allegation that “Staff mishandled a resident's medications while in care,” it is alleged that the staff is not dispensing medications as prescribed. A review of R1’s April 2025 QuikMAR showed that several medications scheduled for twice daily were not administered correctly. For example, the Sodium Chloride 1GM Tablet prescribed by the doctor on April 8 was intended to be taken twice daily, in the morning and evening. The department's April 2025 QuikMAR records indicated that R1 did not receive the medication from April 8 to April 13. Later, in May 2025, the QuikMAR record showed the medication was given from May 1 to May 15, 2025, except for the morning of May 16 and the afternoon of May 17. The Department interviewed three staff members, #1-3 (S1-S3). Two of the three staff members suggested that medication handling was mishandled during R1's care. The Department also interviewed the Executive Director (ED), who stated that QuikMAR identified inconsistencies in the administration of R1’s sodium tablets and other medications. However, the facility staff provided quality care to residents. Additionally, the Department interviewed MP, who was unable to confirm whether the medication mishandling caused R1’s hospitalization. The Department also interviewed R1, who said R1 liked living there. During interviews on 11/12/2025, six residents (R1-R6) were asked whether staff had signed off and whether Med Tech had provided medications; all six confirmed that Med Tech had given them their medications as prescribed. During the investigation, the Department found evidence supporting the allegations. Based on the Department interviews which were conducted and record review (s), the preponderance of evidence standard has been met, therefore the above allegation(s) is found to be Substantiated. California Code of Regulations (Title 22, Division 6 & Chapter 8) is being cited on the attached LIC 9099D. Deficiencies were cited. A copy of this report and the appeal rights were provided to the Executive Director, Jakini Robert. Allegation: #1: Staff neglect resulted in a resident to be hospitalized The complaint alleged that, due to their negligence in managing R1's medications, sodium chloride was not administered to R1, who had recently been prescribed it by an emergency room physician (ER). R1 ended up in the hospital for a week with severe hyponatremia. On 06/13/2025, the Department interviewed the Executive Director (ED) and the three staff members #1-3 (S1-S3), who acknowledged a possible error in documenting medication administration. On 08/01/2025, the Department interviewed the Medical Physician (MP), who stated that it is difficult to determine whether any lack of medications caused the hospitalization of resident #1 (R1). They also stated that R1's declining health could be a factor. On 11/12/2025, the department interviewed six residents, #1-6 (R1-R6), all of whom denied the allegation and stated that facility staff helped them with their medications. R1 also stated that R1 likes living at the facility and receiving medication as prescribed. Regarding the allegation, “Staff neglect resulted in a resident being hospitalized,” based on record reviews and interviews, the Department found no evidence to support the allegation mentioned above. Although the allegation may have occurred or be valid, there is not a preponderance of evidence to prove whether the alleged violation did or did not occur; as a result, the allegation is Unsubstantiated. No deficiencies were cited. An exit interview was conducted. A copy of the report was provided to the Executive Director Jakini Robert.the state’s words, verbatim · CDSS document, Feb 13, 2026 · control 11-AS-20250520093313

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87506(a) · Plan of correction due date: Feb 17, 2026

87506 Resident Records (a)The licensee shall ensure that a separate, complete, and current record is maintained for each resident in the facility or in a central administrative location readily available to facility staff and to licensing agency staff. Based on observations, interviews, and record review Staff failed to ensure medications were provided to R1, that were signed off as administered. This poses an immediate health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Feb 13, 2026

Plan of correction: Administrator will develop a plan to ensure that medication administration records are checked frequently to avoid discrepancies. Administrator will submit plan to LPA by POC due date. CIVIL PENATLY ASSESSED.

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(a)(4 · Plan of correction due date: Feb 17, 2026

87465 Incidental Medical and Dental Care ...The licensee shall assist residents with self-administered medications as needed. This requirment has not been met as evidenced by: Based on observation, interviews and records review the administrator failed to ensure medication for resident R1 medications reviewed was not adminstrated accurately. This poses an immediate health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Feb 13, 2026

Plan of correction: Administrator will develop a plan to ensure that medication administration records are checked frequently to avoid discrepancies. Administrator will submit plan to LPA by POC due date.

Allegation investigated: Staff are not releasing resident's records to their responsible party as required.

This complaint investigation report supersedes the report delivered on 01/30/2026 and the findings have been changed. On 02/13/2026, Licensing Program Analyst (LPA) Antonine Richard conducted a subsequent visit to deliver findings. LPA met with Executive Director Robert Jakini and the purpose of the visit was explained. Investigation consisted of the following: On 01/30/2026, LPA obtained Personnel Report, Register of Residents, Resident #1’s (R1) Resident Lease Agreement, Telecommunications Device Notification, Release of Resident Medical Information, Consent for Emergency Medical Treatment, Personal Rights, Facility Assessment Determination Addendum, Uniform Statutory Form Power of Attorney, and Provider Service Contract between LA Coast PACE, LLC and Regency Palms Senior Living. LPA interviewed Staff #1 - #4, Witness #1, and Residents #5 - #9. LPA attempted to interview R1 – R4 and Witnesses #2 - #5. Report Continued on LIC9099C Substantiated Investigation revealed the following: Allegation: Staff are not releasing resident's records to their responsible party as required. Regarding the allegation, “Staff are not releasing resident's records to their responsible party as required, it is being alleged that the staff did not release Resident #1’s (R1) records to a third party with verbal consent from the Power of Attorney (POA). Record review of Provider Service Contract between LA Coast PACE, LLC and Regency Palms Senior Living (10/01/2023) revealed the facility agreed to release participants records in Article 4: Books, Records and Reports; Inspection. Review of R1’ Facility Assessment Determination Addendum (02/20/2024) revealed the facility services, PACE covered services, and daily reimbursement. Interview with W1, R1’s POA, indicated W1 provided verbal consent to the third party. W1 also indicated the facility has a contract with the third-party agency. Four out of five resident interviews (R5 – R9) were unable to confirm if the facility would release their medical records to self, family, or third parties. Regarding the allegation, “Staff are not releasing resident's records to their responsible party as required,” based on record review and interviews, the preponderance of evidence standard has been met, therefore the above allegation(s) is found to be substantiated. California Code of Regulations, Title 22, is being cited on the attached LIC 9099D. An exit interview was conducted, plans of correction developed, and a copy of this report with appeal rights was provided to the Executive Director Jakini Robert.the state’s words, verbatim · CDSS document, Feb 13, 2026 · control 11-AS-20260128122053

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.2(a)(2) · Plan of correction due date: Feb 27, 2026

(2)To have their records and personal information remain confidential and to approve their release, except as authorized by law. This requirement was not met as evidence by: Based on records review and interviews, The Licensee did not release R1’s records as authorized by law which poses a potential personal right risk to client in care. A Contract between LA Coast PACE, LLC and facility commenced on 10/01/2023 which includes an agreement to provide participant records. Plus, R1’s POA provided consent.the state’s words, verbatim · CDSS document, Feb 13, 2026

Plan of correction: POC Due Date: 02/27/26 POC: The Licensee will email evidence of correction to regina.cloyd@dss.ca.gov.

Allegation investigated: Staff do not ensure that resident's incontinence needs are met Staff do not assist resident with repositioning

On 02/05/2026, Licensing Program Analyst (LPA), Wendy Gibbs, conducted an unannounced subsequent Complaint Visit to the facility listed above to deliver findings. LPA met with Executive Director, Robert Jankini, and the purpose of today’s visit was explained. LPA was granted entry into the facility. The investigation consisted of the following: During an initial visit conducted on 11/24/2025, LPA Brown received the following documents: Resident Roster (received on 11/24/2025), Staff Roster (received 11/24/2025), & the following records for Resident 1 (R1): LIC 601 Identification & Emergency Information (dated 04/15/2025), LIC 602 Physician's Report (09/30/2024), Service Plan (dated 07/29/2025) and Admission Agreement (dated 03/25/2025). During a subsequent visit conducted on 12/05/2025, LPA inspected the facility, interviewed Staff S1, interviewed Residents R1-R7, and received and reviewed an LIC602 Physician’s Report (dated 02/15/2023), Incontinent Resident list, and Non-Ambulatory Resident list. During a subsequent visit conducted on 01/15/2026, LPA interviewed Staff S2-S10. The investigation revealed the following: Unsubstantiated Allegation: Staff do not ensure resident’s incontinence needs are met. The allegation alleges that during the night the caregivers do not check on them or change their diapers. During the facility inspection, LPA observed staff asking residents if they need to go to the restroom or if they need changed. During record review, LPA received and reviewed Resident R1’s Service Plan (dated 07/29/2025) that indicates R1 requires assistance with PM and nighttime incontinent care. LPA observed safety checks are to be done four (4) times per shift is listed as a Special Care Need. LPA received and reviewed Resident R1’s Physician Report (dated 09/30/2024) that comments patient requires assistance with toileting. Additionally, LPA received and reviewed Staff S2-S10 training records that indicate staff have received the following training on Relias within the last year, Restorative Nursing: Bowel and Bladder for the CNA, Managing Urinary Incontinent, and Care of the Bedridden Individual. LPA received and reviewed In-Service logs regarding Handling Residents with Care while Providing Incontinent Care, Peri Care, Toileting Log, and Incontinent Supplies. During interviews with Staff S1-S10, were asked how often residents are checked/assisted with changing briefs/diapers, ten (10) out of ten (10) stated they are checked/assisted every 30 minutes to two (2) hours depending on the residents. Additionally, Staff S1-S10 were asked if there was a time when they came into work and observed a resident in soiled diapers, seven (7) out of ten (10) stated no, they have not come into work and found a resident in soiled briefs/diapers. Three (3) out of ten (10) stated there was a time when they have come in and a resident was soiled, and they were informed during crossover, the resident at the time was refusing assistance with being changed. During interviews with Residents R1-R7, they were asked if there has been a time they were left in soiled diapers for an extended period of time, three (3) out of seven (7) stated no they have not been left in soiled diapers or briefs for an extended period of time. Two (2) out of seven (7) stated they had been left in soiled diapers for 5 to 15 minutes due to staff assisting other residents. Two (2) out of seven (7) stated they do not require assistance changing their briefs. Additionally, during interviews Residents R1-R7, were asked if staff check on them during the night to see if they need changed, five (5) out of seven (7) stated yes, staff come and check on them at night to see if their diaper or briefs need changed. Two (2) out of seven (7) stated they are not sure if staff check to see if they need changed at night. Allegation: Staff do not assist residents with repositioning. The allegation alleges that staff do not help a resident reposition for meals. During the facility inspection, LPA observed staff bring lunch to residents’ rooms. For residents who were having their meal in bed, LPA observed staff assist the residents up higher on the mattress before they raised the resident’s head. During record review, LPA received and reviewed resident R1’s Service Plan (dated 07/29/2025) that indicates R1 requires support with ambulation, mobility and repositioning. An added note states “Provide additional staff support to help with repositioning in bed. Additionally, LPA received and reviewed Staff S2-S10 training logs that indicate staff have received the following training on Relias within the last year, Assisting With Proper Positioning, Promoting Safe Eating, and Care of the Bedridden Individual. LPA received and reviewed In-Service training logs regarding Transfers/2 person assist and Rotating Bed Bound/Wheelchair Bound Residents. During interviews with Staff S1-S10, were asked if residents are assisted with proper positioning before receiving their meals, ten (10) out of ten (10) stated yes, they ensure the residents who are non-ambulatory or bedridden are positioned properly before eating meals. During interviews with Residents R1-R7, were asked if staff ensure they are positioned properly during meals, six (6) out of seven (7) stated yes staff ensure they are positioned properly. One (1) out of seven (7) stated they do not require assistance with positioning during meals. During the course of the investigation, LPA was unable to find evidence to support the allegation(s). Although the allegation(s) may have happened or is valid, there is no preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation(s) is/are unsubstantiated. During today’s visit, LPA did not observe or cite any deficiencies. An exit interview was conducted with Executive Director, Robert Jakini, and a copy of this report was provided.the state’s words, verbatim · CDSS document, Feb 5, 2026 · control 11-AS-20251118110841

Allegation investigated: Staff are not releasing resident's records to their responsible party as required.

On 01/30/2026, Licensing Program Analyst (LPA) Regina Cloyd conducted an initial visit to gather information regarding the above allegation. LPA met with Alyssa Rios and the purpose of the visit was explained. LPA spoke with Executive Director Robert Jakini over the phone. Investigation consisted of the following: On 01/30/2026, LPA obtained Personnel Report, Register of Residents, Resident #1’s (R1) Resident Lease Agreement, Telecommunications Device Notification, Release of Resident Medical Information, Consent for Emergency Medical Treatment, Personal Rights, Facility Assessment Determination Addendum, and Uniform Statutory Form Power of Attorney. LPA interviewed Staff #1 - #4, Witness #1, and Residents #5 - #9. LPA attempted to interview R1 – R4 and Witnesses #2 - #5. Continue to LIC9099-C. Unsubstantiated Investigation revealed the following: Regarding the allegation, “Staff are not releasing resident's records to their responsible party as required, it is being alleged that the staff did not release Resident #1’s (R1) records to a third party with verbal consent from the Power of Attorney (POA). Record review of Uniform Statutory Form Power of Attorney (04/20/2023) revealed Witness #1 (W1) has all financial powers for R1. Review of R1’ Facility Assessment Determination Addendum (02/20/2024) revealed the facility services, PACE covered services, and daily reimbursement. Review of Release of Resident Medical Information (02/13/2024) revealed R1’s Primary Care Physician is authorized to release R1’s medical or confidential information to the facility. LPA did not observe release of resident medical information to the third party. Interview with the Executive Director (S1) indicated staff cannot release records without the family’s permission. Interview with Staff #3 indicated a release form is required for records and the facility will also speak with their consultants and counsel for advice. Interview with W1 indicated W1 did not provide written consent to the third party nor to the facility. Four out of five resident interviews (R5 – R9) were unable to confirm if the facility would release their medical records to self, family, or third parties. Regarding the allegation, “Staff are not releasing resident's records to their responsible party as required,” although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated. An exit interview was conducted and a copy of this report with was reviewed the Executive Director and left with Staff Alyssa Rios.the state’s words, verbatim · CDSS document, Jan 30, 2026 · control 11-AS-20260128122053

Allegation investigated: Staff does not provide adequate supervision resulting in resident physically abusing another resident(s). Staff is wrongfully evicting resident.

*This report supersedes report dated 09/17/25, this report is only changing the verbiage and does not change the report findings from 09/17/25*. On 09/17/25, at 9:16am, Licensing Program Analyst (LPA) Perry Scott conducted an initial complaint visit to the facility and was greeted by Robert Jakini, Executive Director. LPA explained the purpose of this visit is to gather information about the complaint, gather facility files, interview staff and residents, and deliver findings for the allegations mentioned above. The investigation consisted of the following: The department investigated the allegations mentioned in this complaint; and conducted interviews with staff (S1-S4) and residents (R1-R8). The department received the following facility documents: Resident Roster (Date: No Date) and Staff Roster (Dated: No Date). The department also received documents for resident’s (R1 and R2): Physician Report (Dated: 8/19/2024 & 9/9/2024), ID/Emergency Information (Dated: 09/17/2025 & 8/24/2024), Resident Lease Agreement (Dated: 08/24/2024 & 10/29/2024), Resident Assessment (Dated: 07/29/25 & 4/24/2025),.... Report Continued on LIC909-C Unsubstantiated Preplacement Appraisal Information (Dated: 9/16/2024 & 8/24/2024), Incident Reports (Dated: 3/13/2025 & 4/13/2025), Unauthorized Use Of Cameras Warning Notice (Dated: 05/08/2025), and Eviction Notice (Dated: 05/21/2025) from the facility. The investigation revealed the following: Allegation #1-Staff does not provide adequate supervision resulting in resident physically abusing another resident(s). The details of the complaint alleged that the facility does not provide adequate supervision, leading to conflicts and altercations with the residents. On 09/17/25, from 9:30am-2:00pm, the department interviewed staff (S1-S4) and residents (R1-R8) regarding the allegation. 4 of 4 staff denied the allegation that Staff does not provide adequate supervision resulting in resident physically abusing another resident(s). All staff (S1-S4) stated the facility has more than enough staff to provide adequate care and supervision for the residents. They also state that on occasion some residents do have behavior problems and arguments with other residents and staff. They state that when these situations occur, there are staff present and available to counsel, coach, and redirect the resident’s behavior and to prevent things from going any further. They further state that when a resident makes contact with staff or another resident, it is documented and reported to the Community Care Licensing Division (CCLD), the resident’s physician, Ombudsman, family, and any other parties that may have power of attorney over the resident. The department interviewed residents (R1-R8) about the allegation and 8 of 8 residents that were interviewed stated that there is enough staff to adequately care for and supervise the residents in the facility. They also stated that they feel safe living in the community among the staff and the other residents. The department reviewed the Staff Roster (Dated: No Date), Incident Reports (Dated: 3/13/2025 & 4/13/2025), Resident Assessment (Dated: 07/29/25 & 4/24/2025), and Preplacement Appraisal Information (Dated: 9/16/2024 & 8/24/2024) and observed that the facility has enough staff to meet the needs of the residents served. Report Continued on LIC9099-C The department did not find any evidence that the facility failed to have proper staffing, causing the residents to be unsupervised. Based on interviews, and records reviewed, there is insufficient evidence to support the allegation that Staff does not provide adequate supervision resulting in resident physically abusing another resident(s). 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 #2- Staff is wrongfully evicting resident. The details of the complaint alleged that the facility is wrongfully evicting the resident (R1) because of cameras in the residents’ room and violating general policies. On 09/17/25, from 9:30am-2:00pm, the department interviewed staff (S1-S4) and residents (R1-R8) regarding the allegation. 4 of 4 staff denied the allegation that Staff is wrongfully evicting resident. Staff (S1) stated that the resident (R1) was not wrongfully evicted. S1 stated that an eviction notice was issued to R1 on 05/21/2025, due to violating the facilities admission agreement. S1 stated that use of unauthorized video surveillance devices with an audio component, was a contributing factor to the eviction notice, which is not allowed at the facility as stated in the admission agreement which was signed by R1s responsible party on 08/24/2024. S1 further stated that the resident violated other general policies of the facility, such as violent behavior towards staff and other residents. The department interviewed residents (R1-R8) about the allegation and 7 of 8 residents that were interviewed stated that they have not been issued an eviction notice or are being wrongfully evicted. They state that they are happy living at the facility and feel safe in their community. The department reviewed the Eviction Notice (Dated: 05/21/2025), Unauthorized Use of Cameras Warning Notice (Dated: 05/08/2025), and the Resident Lease Agreement (Dated:08/24/2024). The department observed that the resident was in violation of the general policies of the facility as outlined in section 10.9 of the resident’s lease agreement and for violating Title 22 regulations section 87224(a)(3) Eviction Procedures: Failure of the resident to comply with general policies of the facility. Report Continued on LIC9099-C Additionally, another general policy of the facility was violated by the resident, which are the House Rules section 7.7 of the resident’s lease agreement that states, “residents should be respectful to all staff and residents, and further states that failure to comply with this rule may result in the issuance of a 30-day notice”. The facility staff (S1) stated the resident was violent towards staff and residents. The department has confirmed that the eviction notice was sent to Community Care Licensing Division within 5 days of issuance and based on the review of the notice, it is in compliance with Title 22 regulations. Based on interviews, and records reviewed, there is insufficient evidence to support the allegation that Staff is wrongfully evicting resident. 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 because of neglect, therefore the allegation is Unsubstantiated. No citations were issued. An exit interview was conducted with Robert Jakini, Executive Director, and a hard copy of this Complaint Investigation Report was provided.the state’s words, verbatim · CDSS document, Jan 15, 2026 · control 11-AS-20250911232048

Allegation investigated: Staff did not prevent resident from developing multiple pressure injuries while in care Staff do not assist resident with obtaining medical care

On 12/30/2025 at 08:13 am, Licensing Program Analyst (LPA) Zina Brown conducted a subsequent visit at this facility to deliver the complaint findings for the allegations above. During the visit, the LPA met with Robert Jakini (Administrator), and the purpose of the visit was explained. The investigation consisted of the following: On 10/25/2025, Licensing Program Analysts (LPAs) Zina Brown & Lizeth Villegas conducted a health and safety check for Resident 1 (R1) in care. On 10/25/2025, LPAs obtained records for R1, including the LIC 601 Emergency Identification (dated 04/27), LIC 602 Physician Report (dated 05/28/2025), Face Sheet & Emergency Info (printed 10/24/2025), Resident Assessment (created on 03/31/2025), Service Plan (dated 07/29/2025), Durable Power of Attorney for Health Care (03/01/1993), Hospice Care Plan, Staff Roster & Resident Roster. During the 10/25/2025 visit, LPAs did not observe any immediate health & safety issues. On 11/04/2025, between the hours of 8:42am - 12:20pm, LPA conducted interviews with Administrator (A1), Staff 1-7 (S1 - S7),& Residents 1-8 (R1-R8). R1& R2 were unable to be interviewed due to communication barriers. Report continues on LIC 9099-C Unsubstantiated The investigation revealed the following: Allegation: Staff did not prevent a resident from developing multiple pressure injuries while in care. It was alleged that a resident developed a pressure injury on the buttock area that was approximately the size of a grapefruit. It was further alleged that the pressure injury was severe, with visible muscle and tissue exposed and no skin covering the affected area. Additionally, it was alleged that the resident had two additional pressure injuries located on the hips. The reporting party was unsure of the staging of these pressure injuries. On 11/04/2025, between the hours of 11:25am - 11:45am, the LPA interviewed Administrator (A1) regarding the allegation. A1 denied the allegation and stated the wound is unstageable and located on the coccyx of the resident. The facility defers wound care to the hospice care nurse, and the facility only changes dressings if soiled. A1 also mentioned the resident is repositioned as needed and has been provided an alternating pressure mattress (APP) that inflates and deflates to relieve pressure. The wound care nurse sees R1 three times a week, with the wound being cleaned, bandages changed, and debridement performed. On 11/04/2025, between the hours of 8:42 am -12:20pm, the LPA interviewed 7 staff regarding the allegation. 4 of 7 staff members denied the allegation and stated there were no concerns with staff properly repositioning or cleaning pressure injuries as directed by the facility and the wound care nurse. 3 of 7 staff members did not confirm nor deny the allegation and stated not working on the floor that the resident resides and did not express any concerns repositioning or cleaning the resident's pressure injury. On 11/04/2025, between the hours of 9:09am - 10:47am, the LPA interviewed 6 residents regarding the allegation. 6 of 6 residents denied the allegation and stated they have never experienced having any pressure injuries nor receiving wound care from a nurse. On 11/04/2025, LPA observed in R1's room that the facility provided the resident with a mattress that is specific for non-ambulatory or bedridden residents to help minimize pressure injuries. Report continues on LIC 9099-C On 12/22/2025 between the hours of 3:00pm - 4:30pm, LPA reviewed R1's LIC 602 Physician's Report for Residential Care Facilities for the Elderly (RCFE) (dated on 05/28/2025) which states on page 3 of 6 that Resident 1 (R1) has a history of skin breakdown located on sacral and buttocks areas. LPA conducted a records review of R1's Service Plan (dated 07/25/2025) on page 4 of 8 which states under Special Care Need resident has active wounds/skin breakdown with a history of open skin to heels and or coccyx area. Also under the transfer section of the service plan on page 3 of 8 the resident receives two person assistance with transferring and repositioning on a daily bases. LPA reviewed Hospice Care Plan from Compassionate Hospice Care, Inc (dated 11/13/2024) stated R1's treatment consist of bilateral buttocks skin care maintenance: Wash with mild soap and rinse: thoroughly with warm water, pat dry, apply calmoseptine ointment topically to buttocks skin and leave open to air daily and as needed. LPA reviewed Wound Care Progress Notes from Compassionate Hospice Care, Inc./Empire Wound Care for Resident 1 (R1). Documentation dated 10/03/2025 indicated R1 had multiple wounds, including a Stage 4 pressure injury located at the center midline sacrococcyx with a duration of greater than two years and pre-debridement measurements of 4.6 cm x 8.6 cm x 0.4 cm. R1 also had a wound on the left medial second toe with a duration of six weeks and pre-debridement measurements of 0.7 cm x 0.5 cm x UTD. In addition, R1 had a Stage 3 pressure injury on the left posterior distal buttocks with a duration of four weeks and pre-debridement measurements of 3.1 cm x 2.5 cm x 0.1 cm, as well as a Stage 3 pressure injury on the right posterior distal buttocks with a duration of six weeks and pre-debridement measurements of 3.5 cm x 2.5 cm x 0.1 cm. On 10/10/2025, which indicated the center midline sacrococcyx wound remained at Stage 4 with pre-debridement measurements of 4.3 cm x 8.5 cm x 0.3 cm and post-debridement measurements of 4.4 cm x 8.6 cm x 0.4 cm. The left medial second toe wound remained at the same stage with a seven-week duration and pre-debridement measurements of 0.7 cm x 0.5 cm x UTD, with no post-debridement measurements documented. The left posterior distal buttocks wound remained Stage 3 with an eight-week duration and pre-debridement measurements of 3.1 cm x 2.3 cm x UTD and post-debridement measurements of 3.2 cm x 2.4 cm x 0.2 cm. The right posterior distal buttocks wound also remained Stage 3 with pre-debridement measurements of 3.4 cm x 2.5 cm x 0.05 cm, and no post-debridement measurements were documented. Further review of wound care documentation dated 10/17/2025, 10/24/2025, and 10/31/2025 indicated that all previously identified wounds remained at the same stage and with no significant changes in measurements. Documentation dated 10/24/2025 additionally noted a new wound located on the left lateral third finger with a duration of one week and measurements of 0.4 cm x 0.4 cm x 0.1 cm. Based on observation, LPA observed a repositioning chart posted in Resident 1’s room, which served as a reminder for staff regarding scheduled repositioning needs for R1. The Department interviewed the responsible party for R1, who stated they did not have any concerns regarding the allegations listed above. The Department also interviewed Witness 1, who stated they had no concerns regarding staff repositioning of Resident 1 or the cleaning and care of the resident’s wounds. Based on the information gathered, interviews, and record reviews, there is not enough evidence to support that Regency Palms Long Beach failed to provide proper care to Resident 1 resulting in pressure injures for 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 assist resident with obtaining medical care It was alleged that the resident teeth are rotting and the reporting party doesn't know if R1's is getting dental care. On 11/04/2025, between the hours of 11:25am - 11:45am , LPA interviewed Administrator (A1) regarding the allegation. A1 denied the allegation. A1 stated that depending on the resident's care plan, prompting and/or assistance is provided two times per day, as tolerated, for how often residents' teeth are brushed throughout the day. As it pertains to R1, the facility swabs their teeth, as the resident cannot safely swallow and is an aspiration risk. Additionally, R1's teeth show signs of decay consistent with her age and previous dental care. A1 stated the facility does not coordinate dental care for R1, as this matter is managed by the family. A1 also mentioned that at this point of R1's disease process, the resident could not receive dental care, as they could not get a dentist and R1 would not be able to survive the procedures. R1 is currently on hospice at the end of life, and comfort care is being administered per her Power of Attorney (POA). Report continues on LIC 9099-C On 11/04/2025, between the hours of 8:42am - 12:20pm, LPA interviewed 7 staff members regarding the allegation. 7 of 7 staff denied the allegation and stated the residents' teeth are brushed every shift in the morning/evening and after every meal. On 11/04/2025, between the hours of 9:09am - 10:47pm, LPA interviewed 6 resident interviews regarding the allegation. 6 of 6 residents denied the allegation and stated staff do not assist with brushing their teeth, as the residents independently brush their own teeth. 2 of 6 residents said they have not had any dental procedures conducted. 2 of 6 residents stated their family and/or friends assist with their dental care needs. 1 of 6 residents stated they wish to go to the dentist since they have not been to the dentist while living at the facility.1 of 6 residents stated they went to the dentist three months ago. On 12/22/2025 between the hours of 3:00pm - 4:30pm, LPA conducted a records review of R1's Service Plan (dated 07/25/2025) on page 2 of 8 which states under the dental section full assistance with oral care On 10/28/2025 at 2:45pm, the department interviewed the responsible party for R1 who stated arranging for a mobile dentist to visit since R1 who is bed bound. The responsible party for R1 also stated visiting the facility daily to ensure her teeth are brushed properly. Although R1's responsible party did express concerns via email with staff regard frequency of R1's teeth being brushed based on the information gathered, interviews, and record reviews, there is not enough evidence to support that Regency Palms Long Beach failed to provide proper care to Resident 1 in regards to teeth rotting for 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 providedthe state’s words, verbatim · CDSS document, Dec 30, 2025 · control 11-AS-20251024095919

Allegation investigated: Facility staff are not properly trained.

On 12/18/2025 at 08:10 am, Licensing Program Analyst (LPA) Zina Brown conducted a subsequent visit at this facility to deliver the complaint findings for the allegation above. LPA met with Robert Jakini (Administrator) and explained the purpose of the visit. The investigation consisted of the following: On 08/11/2025 at 1:20pm, Licensing Program Analysts (LPAs) Zina Brown, Ernand Daubet, Lizeth Villegas and Licensing Program Manager (LPM) Janae Hammond conducted an unannounced initial complaint visit at this facility. During today’s visit, LPAs and LPM met with Robert Administrator and explained the purpose of the visit. LPAs conducted interviews with Administrator (A1), Staff (S1-S4) & Residents (R1-R8) between the hours of 2:15 pm - 3:41 pm. LPA requested copies of Resident Roster (received on 08/11/2025), Staff Roster (received 08/11/2025), ALW Resident List, Admission Agreement for ALW Resident, Invoices for Returned Rent Checks/Fees, Sign In Sheet (for month of August 2025) Memory Care Staff training from initial to present. Report continues on LIC 9099-C Substantiated Please be advised: When the Department initiated this investigation, at the time that Variola Marciano was serving as the facility’s Administrator. The investigation revealed the following: Allegation: Facility staff are not properly trained It was alleged that staff in the memory care new hires are not properly trained. On 08/11/2025, LPA interviewed Administrator (A1) regarding the allegation. A1 denied the allegation. A1 states he believes his staff is properly trained as ongoing trainings are provided such as in-services, annual training, Relias and shadowing. On 08/11/2025, between 2:30pm -3:50pm and on 10/02/2020 between the hours of 10:17am - 12:21pm, LPA interviewed 11 staff regarding the allegation: 2 of 11 staff confirmed the allegation and stated if staff is a first-time caregiver needs additional training. 6 of 11 staff denied the allegation and stated all staff are properly trained. 3 of 11 staff did not confirm nor deny the allegation and stated speaking for themselves that they have been properly trained . On 08/11/2025, between 2:30pm -3:50pm and on 10/02/2020 between the hours of 10:00am -11:43am, LPA interviewed 9 residents: 9 of 9 residents denied the allegation and stated the staff appear to be trained and knowledgeable when assisting the residents. On 12/05/2025, between 8:30am and 2:25pm, the LPA conducted a records review and noted the following: A total of 27 caregivers work in the memory care unit. 11 caregivers participated in the required 2024–2025 training curriculum, which consists of 46 topics, including dementia care, incontinence care, medication assistance, care for bedridden residents, communication, person-centered care, hospice services, residents’ rights, infection control, and recognizing and reporting abuse, among other mandated subjects. Upon discovery, here is the training completion levels w as follows: 46 topics completed by 2 caregivers, both employed for 4 and 7 months. 40–45 topics completed by 3 caregivers, each employed for approximately one year. 8–24 topics completed by 6 caregivers; 2 have been employed since 2023 and 4 have been employed since 2024. Based on LPAs observations and interviews which were conducted and the records that were reviewed, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED under California Code of Regulations, Title 22, Division 6 and Chapter 8 are being cited on the attached LIC 9099D. Exit interview conducted with Robert Jakini (Administrator) and a copy of this report & appeal right were provided. Please be advised: When the Department initiated this investigation, Fabiola Marciano was serving as the facility’s Administrator. The investigation revealed the following: Allegation: Facility is overcharging residents for rent It was alleged that the facility Administrator has been sending back Resident 1 (R1) payments for rent and cannot send back check payments. On 08/11/2025, LPA interviewed Administrator (A1) regarding the allegation. A1 denied the allegation and stated residents are given a clear breakdown of their rent and any additional fees. A1 says the people in question not being charged due to eviction. The attorney suggested this to send back payment if it is sent to the facility. ALW rent amount is $1,600 which is not listed on the facility Admission Agreement. A1 also stated care component and rent component are all combines sand ALW makes determination of rent supplement. On 08/11/2025, between 2:30pm - 3:50pm and on 10/02/2025 between the hours of 10:17am - 12:21pm, LPA interviewed 11 staff regarding the allegation: 11 of 11 staff were unaware of the allegation and stated not having any knowledge of the facility overcharging residents for rent. On 08/11/2025, between 2:30pm -3:50pm and on 10/02/2025 between the hours of 10:00am -11:43am, LPA interviewed 9 residents: 8 of 9 residents denied the allegation and stated the facility rent is fair for residents. 1 of 9 residents did not confirm nor deny the allegation and stated not having any knowledge of whether rent is fair On 12/05/2025, between the hours of 9:22am - 9:30am, LPA conducted a records review and observed the following: Invoices for Memory Care (MC) rent for Apartment 303A for Resident 1 in the amount of $1,600 were documented as follows: MC Rent Invoice Date/Due Date: 08/31/2024 – $721.55 . Other Charges Invoice Date/Due Date: 08/31/2024 – $412.90 . Monthly MC Rent Invoice Date/Due Date: 09/01/2024, 10/01/2024, 11/01/2024, 12/04/2024, 01/01/2025, 02/01/2025, 03/01/2025, 04/01/2025, 05/01/2025, 06/01/2025 – $1,600 each. The Regency Lease Agreement, signed and dated on 08/24/2024 by Resident 1’s authorized representative, indicates that the agreement was entered into on 08/24/2024 for Apartment 303A on a month-to-month basis beginning 08/24/2024, with an apartment fee of $1,600 per month and a waived ALW care fee, for a total of $1,600 per month, payable in advance on the first day of each month. Based on information gathered through interviews and record reviews, there is not enough 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 UNSUBSTANTIATED. Allegation: Facility staff are not properly administering residents’ medication It was alleged that resident was not consistently receiving medication on a regular basis. On 08/11/2025, LPA interviewed Administrator (A1) regarding the allegation. A1 denied the allegation. A1 stated the Medication Administrated Record (MAR) informs the facility what time to dispense the prescribed medication to each resident. A1 states all staff are provided training on Relias and by the pharmacy. At times if there is no order it will cause a delay particular from the Va and Kaiser which slows the process down. The facility documents medication refusals and if there are suspected or identified it is verified and reported to the residents' family. On 08/11/2025, between 2:30pm -3:50pm and on 10/02/2025 between the hours of 10:17am - 12:21pm, LPA interviewed 11 staff regarding the allegation: 3 of 11 staff did not confirm nor deny the allegation and stated not having any knowledge of any reported medication errors. 8 of 11 staff were unaware of the allegation and stated not administering medication to the residents On 08/11/2025, between 2:30pm -3:50pm and on 10/02/2025 between the hours of 10:00am -11:43am, LPA interviewed 9 residents: 9 of 9 residents denied the allegation and stated their medication is always administered on time. On 08/11/2025, between the hours of 1:40pm - 2:50pm, LPAs conducted a medication administration review and observed the following: All medications were counted and matched the residents medication administrator record (MAR): 2nd Floor:The resident in Room 202B takes 4 pills in the morning, 1 pill at noon, and 4 pills in the evening/bedtime.The resident located in Room 202A takes 5 pills in the morning, 1 weekly pill in the morning, 1 pill at noon, and 3 pills in the evening/bedtime 3rd Floor: For Resident 1 (R1), LPA counted 4 remaining pills for Levofloxacin. The prescription started on 08/10/2025 and must be administered daily at 7 p.m. per physician orders. For R1’s Myrbetriq, which started on 07/22/2025 with 30 tablets, there were 9 pills remaining as of 08/11/2025. Resident 3 (R3) takes 5 pills in the morning, 1 pill at noon, and 3 pills in the evening/bedtime. The resident located in Room 302B a takes 9 pills in the morning, 1 pill at noon, and 5 pills in the evening/bedtime.M. Barras takes 7 pills in the morning, 1 pill at noon, and 3 pills in the evening. 4th Floor: For the resident located in Room 301A, LPA counted 30 pills for each prescribed medication. The resident takes 5 medications in the morning and 3 in the evening. On 08/06/2025, the facility documented on the MAR that the following medications were not administered—Memantine HCL 10 mg, Donepezil HCL 10 mg, Januvia 50 mg, Rosuvastatin Calcium 20 mg, and Metformin HCL 500 mg—due to the resident being out of the facility at a day center program. The resident located in Room 407 takes 3 pills in the morning and 3 pills in the evening/bedtime. Based on information gathered through interviews and record reviews, there is not enough 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 UNSUBSTANTIATED. Allegation: Facility staff are harassing residents It was alleged that staff are intentionally harassing resident to cause behaviors due to them trying to push . On 08/11/2025, LPA interviewed Administrator (A1) regarding the allegation. A1 denied the allegation. A1 states not witnessing or hearing about any instances of staff behaving inappropriately towards residents . The facility policy is providing care. A1 also stated there is no formal complaints or investigations related to staff harassment towards the staff. However an immediate termination would be in place if staff intentionally harassing resident to cause a behavior. On 08/11/2025, between 2:30pm - 3:50pm and on 10/02/2025 between the hours of 10:17am - 12:21pm, LPA interviewed 11 staff regarding the allegation: 11 of 11 staff denied the allegation and stated have not witness nor heard about staff behaving inappropriately towards the residents. On 08/11/2025, between 2:30pm - 3:50pm and on 10/02/2025 between the hours of 10:00am -11:43am, LPA interviewed 9 residents: 9 of 9 residents denied the allegation and stated the staff treat the resident with respect are kind, and outstanding to the residents On 12/11/2025, between the hours of 2:20pm - 2:30pm, LPA conducted a records review and observed the following: LPA did not observe any incidents reports nor resident notes in regards to this allegation. Based on information gathered through interviews and record reviews, there is not enough 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 UNSUBSTANTIATED. Report continues on LIC 9099-C. Allegation: Facility staff are refusing to provide care to residents It was alleged that caregivers were in R1's room and contacted the med tech for assistance. The med tech stated that he had shown them how to complete the task; however, staff reportedly refused to raise the resident’s bed rails. On 08/11/2025, LPA interviewed Administrator (A1) regarding the allegation. A1 denied the allegation. A1 stated no such thing as care no being provided has happened ; yet staff can be called to help other staff. There are no cases where care was refused nor delayed for the resident but if so, it would be documented. Also, A1 stated in the event of staff failing to provide required care would result in immediate termination. On 08/11/2025, between 2:30pm -3:50pm and on 10/02/2025 between the hours of 10:17am - 12:21pm, LPA interviewed 11 staff regarding the allegation: 11 out of 11 staff denied the allegation and stated there are no documented cases where care is refused or delayed for the residents . However, staff do document when care is /was refused or delayed for residents. On 08/11/2025, between 2:30pm -3:50pm and on 10/02/2025 between the hours of 10:00am -11:43am, LPA interviewed 9 residents: 9 of 9 residents denied the allegation and stated when asking for help, the staff do come help. On 12/11/2025, between the hours of 2:20pm - 2:30pm, LPA conducted a records review and observed the following: LPA did not observe any incidents reports nor resident notes in regards to this allegation. Based on information gathered through interviews and record reviews, there is not enough 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 UNSUBSTANTIATED. Report continues on LIC 9099C Allegation: Facility staff did not allow Home Health agency entry to provide care to resident It was alleged that nurse that comes once a month to change her catheter fire Royal Majesty Home Health Teresa Andaya refused entry on August 2nd and 8:14am ask med tech to unlock door and waited until 8:26am and no one answered, and she had to leave at 8:30am. On 08/11/2025, LPA interviewed Administrator (A1) regarding the allegation. A1 denied the allegation. A1 stated no Home Health agencies were denied entry access on the day of August 2nd at 8am for Resident 1 (R1) as it would be impossible that staff was not available at that time. A1 states the facility does not deny visit as it is a violation of rights. A1 states if Home Health agencies are behaving with the perimeters. On 08/11/2025, between 2:30pm -3:50pm and on 10/02/2025 between the hours of 10:17am - 12:21pm, LPA interviewed 11 staff regarding the allegation: 1 of 11 staff denied the allegation and stated there have no instances where Home Health Agencies such as Royal Majesty home were denied access on August 2, 2025, around 8am for Resident 1 (R1). 10 of 11 staff were unaware of the allegation & stated not having any knowledge of Home Health Agency not being allowed entry to provide care to Resident 1 (R1) On 08/11/2025, between 2:30pm -3:50pm and on 10/02/2025 between the hours of 10:00am -11:43am, LPA interviewed 9 residents: 6 of 9 residents denied the allegation and stated no nurse from an outside agency has ever come to the facility to care for the residents. 4 of 9 residents did not confirm nor deny the allegation and stated a nurse from an outside agency such as Home Health has not been stopped to come into the facility to provide care to the resident. On 12/08/2025, between the hours of 1:45pm -1:55pm LPA conducted a records review and observed the following: On the visitors sign in sheet, Teresa Andaya from Royal Majesty Home Health signed on the following dates and time 08/03/2025 at 12:39pm, 08/12/2025 at 11:03pm and 08/26/2025 at 11:28pm Based on information gathered through interviews and record reviews, there is not enough 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 UNSUBSTANTIATED. Exit interview conducted with Robert Jakini (Administrator) and a copy of this report & appeal right were provided.the state’s words, verbatim · CDSS document, Dec 18, 2025 · control 11-AS-20250807153125

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87411(c) · Plan of correction due date: Jan 19, 2026

Personnel Requirements - General: All RCFE staff who assist residents with personal activities of daily living shall receive initial and annual training as specified in Health and Safety Code sections 1569.625 and 1569.69 Based on observation and interviews, the facility failed to have 16 out 27 caregiver who work in Memory Care complete all the required training in 2025.the state’s words, verbatim · CDSS document, Dec 18, 2025

Plan of correction: The facility will ensure all caregivers who work in memory care complete all the annual training need to be in compliance with Title 22 regulations. The facility will submit the proof of correction to the CCLD/El Segundo ASC Office via fax at 424-544-1016 Attn: Zina Brown or via email at zina.brown@dss.ca.gov by the POC due date.

Allegation investigated: Staff transferred funds from residents bank account without consent.

On 11/13/2025 Licensing Program Analyst (LPA) Jose Calderon conducted an unannounced visit to Regency Palms Senior Living and was greeted by Administrator Robert Jakini (S1). LPA Calderon explained the purpose of this visit is to deliver the findings pertaining to the above-mentioned allegation. The investigation consisted of the following: LPA Calderon interviewed Staff S1, resident R1-R7. LPA Calderon obtained the following records: Admission agreement (dated 01/09/2025), ACH activation and authorization form, signed by R1 (dated 01/10/2025), Demand for payment (dated 10/27/2025), Charges due from resident (dated 01/09/2025), Reviewed billing agreement (dated 01/09/2025), Statement activity (dated 01/01/2025 to 10/31/2025) for R1. The investigation revealed the following: Unsubstantiated Regarding the Allegation: Staff transferred funds from R1 bank account without consent. This complaint alleged that the facility took money out of R1 bank account without permission. Record review indicates the following: Admission agreement indicates that R1 moved into the facility on 01/09/2025. R1 signed the ACH activation and authorization form which allowed the facility to take money out of R1 bank account. Reviewed R1 lease agreement which indicates that R1 had a balance due to the facility from 01/09/2025 to 11/01/2025. Interviews indicate the following: S1 indicates that R1 signed the admission agreement which allowed the facility to withdraw money from R1 bank account. S1 indicates that R1 did not pay R1 full rent and has a balance due. S1 indicates that no eviction notice had been given to R1. R1 indicates that the facility took money out of R1 bank account in January 2025. R1 indicates that R1 did not pay the full amount of rent to the facility. 6 out of 7 staff deny the allegation. Based on interviews and supporting documentation, the preponderance of evidence standard has NOT been met therefore, the allegation of “staff transferred funds from residents bank account without consent” is found to be UNSUBSTANTIATED. No deficiencies cited during today's visit. An exit interview was conducted, and a copy of the Complaint Report was provided to the Administrator Robert Jakini.the state’s words, verbatim · CDSS document, Nov 13, 2025 · control 11-AS-20251107105924

Allegation investigated: Staff did not provide adequate food service to residents in care. Staff did not safeguard resident's personal items. Staff did not meet residents' incontinence needs.

** This report serves as an amendment to clarify findings. It does not supersede the complaint investigation findings reflected on report created 10/15/25. On 10/15/25, the department conducted a subsequent complaint visit to further investigate the above-mentioned allegations and deliver findings. The department met with Robert Jackini, Executive Director, and explained the reason for the visit. The department was granted access to the facility. The investigation consisted of the following: On 12/10/24, the department requested a copy of the staff roster, and resident roster. The department reviewed service records for resident #1 (R1) and collected copies of the following documents: Resident Lease Agreement, Service Plan, Resident Assessment, Preplacement Appraisal Information, Identification and Emergency Information, Physician’s Report, Resident Personal Property and Valuables, Admissions Orders, Resident Notes, Resident Care Plan, Unusual Incident/Injury Report, and Staff schedule (for the dates of 11/25/24-11/28/24). The department conducted interviews with witness #1 (W1) and staff #1 (S1). Unsubstantiated Furthermore, the department conducted a tour of the facility and observed the residents to identify any signs of neglect, abuse or other immediate health and safety threats. On 12/12/24, the department conducted interviews with W1. On 12/13/24, the department conducted interviews with witness #2 (W2), S1. On 12/14/24, the department conducted interviews with W2. On 12/16/24, the department received Hospice Records from Valley Oaks Hospice, Inc. (dated: 12/01/24-12/16/24) for R1. On 12/19/24, the department received EMS records and 911 recording from Long Beach Fire Department. On 12/20/24, the department received the Death Certificate from R1 from Long Beach Department of Health and Human Services. On 12/24/24, the department conducted interviews with W2, and witness #3 (W3). On 12/26/24, the department conducted interviews with staff #2-#5 (S2-S5). On 12/17/24, the department conducted interviews with W1. On 12/31/24, the department conducted interviews with staff #6-S7 (S6-S7). On 01/06/25, the department conducted interviews with witness #4 (W4). On 01/07/25, the department conducted interviews with staff #8-#9 (S8-S9). On 01/09/25, the department conducted interviews with staff #10 (S10). On 01/13/25, the department received Home Health Records for R1 from Royal Majesty Home Care, Inc. On 01/14/25, the department conducted interviews with W1. On 01/15/25, the department received Medical Records from R1’s Gastroenterologist, SoCal Gastroenterology, Hospital Records from St. Mary Medical Center, and Medical Records from Provider 1st R1’s Primary Care Physician. On 01/28/25, the department conducted interviews with witness #5 (W5). On 01/31/25, the department conducted interviews with staff #11 (S11). On 02/03/25, the department conducted interviews with witness #6 (W6). On 02/04/25, the department conducted interviews with witness #7 (W7). On 02/06/25, the department conducted interviews with witness #8 (W8). On 02/10/25, the department conducted interviews with witness #9 (W9) and staff #12 (S12). On 02/11/25, the department conducted interviews with witness #10 (W10). On 02/12/25, the department conducted interviews with witness #11 (W11). On 02/14/25, the department conducted interviews with witness #12 (W12). On 02/19/25, the department conducted interviews with staff #13 (S13). On 02/21/25, the department conducted interviews with S1 and S4. On 02/25/25, the department conducted interviews with W1. On 02/28/25, the department conducted interviews with staff #14-#15 (S14-S15). On 03/07/25, the department received Imaging Records for R1 from St. Mary Medical Center. On 03/14/25, the department conducted interviews with W2. On 03/20/25, the department conducted interviews with witness #13 (W13). On 03/21/25, the department conducted interviews with witness #14-#15 (W14-W15). On 10/15/25, the department requested a copy of the staff roster, resident roster, and the facility menu. The department conducted interviews with staff #2 (S2), staff #16-#20 (S16-S20), and residents #2-#7 (R2- R7). On 11/13/25, the department received an Incontinence List, and a Dietary Restrictions Diet Report. The department was unable to interview R1, as R1 passed away. Furthermore, the department conducted a tour of the facility. The investigation revealed the following: For the allegation: Staff did not provide adequate food service to residents in care. It is being alleged that the food is never cut up nor pureed for the residents that can’t manage a whole chicken breast or a sandwich they couldn’t hold. On 10/15/25, the department conducted interview with S2 and S16-S20. Of those interviewed, 6 out of 6 staff stated that residents are provided adequate food service based on their dietary needs or modified diets. 6 out of 6 staff stated there is enough caregivers to attend to residents during mealtimes. An interview with S16 revealed that the facility accommodates residents and all their dietary needs. S16 said they follow the residents care plan, and they also keep a list of all the residents and their dietary needs in the kitchen for all staff to review. On 10/15/25, the department interviewed R2-R7, and were unable to interview R1, as they passed away. Of those interviewed, 6 out 6 residents denied the allegation. 6 out of 6 residents said they do not have a special diet, and they eat what they want. 6 out of 6 residents said that staff does cut up, and puree residents food. 6 out of 6 residents stated there is enough caregivers to attend to residents during mealtimes. During a review of records, the department observed two weeks of the facility menu. The menu offers a variety of meals throughout the day, such as breakfast, lunch, dinner, including protein, starch, vegetables, and fruits. A review the Staff Roster revealed that the facility has enough staff to meet the needs of the residents served. A review of the facility's Dietary Restrictions Diet Report revealed a list of all the residents and their dietary restrictions (if any). This report is kept in the kitchen for all kitchens staff's review. The department conducted a tour of the facility and observed residents consuming a balanced lunch, which included chicken noodle soup, with a side of fruit, juice, and water. The kitchen was inspected, during which the department observed a five-day supply of perishable food and a seven- day supply of nonperishable food items were noted. The kitchen appeared clean, and no health or safety concerns were observed during the visit. Based on the information gathered, interviews conducted, and records reviewed, the Department found no 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 did not safeguard resident's personal items. It is being alleged that three sets of bedding and towels were purchased prior to a resident moving into the facility, yet there were never any towels, including hand towels to wipe their hands on, and only one sheet on the residents bed. On 10/15/25, the department conducted interview with S2 and S16-S20. Of those interviewed, 6 out of 6 staff denied the allegation. 6 out of 6 staff said they are not aware of a resident missing bedding and towels. 6 out of 6 staff said that the facility provides the residents with basic bedding necessities. On 10/15/25, the department interviewed R2-R7, and were unable to interview R1, as they passed away. Of those interviewed, 6 out of 6 residents said they haven’t had an issue with any of their belongings missing. 6 out of 6 residents said that the facility provides them with basic bedding necessities. During a review of records, the department observed that R1’s Resident Personal/Property and Valuables form (signed/dated: 04/27/23) was blank and had no personal items listed. Based on the information gathered, interviews conducted, and records reviewed, the Department found no 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 did not meet residents' incontinence needs. It is being alleged that there is a lack of changing incontinence at the facility. On 10/15/25, the department conducted interview with S2 and S16-S20. Of those interviewed, 6 out of 6 staff denied the allegation. 6 out of 6 staff stated that residents are checked on at least every two hour or as needed, and depending on their needs. 6 out of 6 staff said residents are not left in soiled briefs for an extended period of time. On 10/15/25, the department interviewed R2-R7, and were unable to interview R1, as they passed away. Of those interviewed, 6 out of 6 residents said they do not require any assistance with toileting. 6 out of 6 residents said that staff check on them frequently. 6 out of 6 residents said they have not observed a resident left in soiled briefs for an extended period of time. During the course of investigation, the department received and reviewed an Incontinence Care List from the facility. According to the list 43 residents listed require incontinence care assistance. Based on the information gathered, interviews conducted, and records reviewed, the Department found no 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. An exit interview was conducted, and a copy of the report was provided.the state’s words, verbatim · CDSS document, Nov 13, 2025 · control 11-AS-20241209124307

Allegation investigated: Staff did not provide adequate supervision to resident in care. Staff did not report resident's incidents to resident's authorized representative.

** This report serves as an amendment to clarify findings. It does not supersede the complaint investigation findings reflected on report created 11/06/25. ** On 11/06/25, the department conducted a subsequent complaint visit to further investigate the above-mentioned allegations and deliver findings. The department met with Robert Jackini, Executive Director, and explained the reason for the visit. The department was granted access to the facility. The investigation consisted of the following: On 12/10/24, the department requested, reviewed and received the following: a copy of the staff roster, resident roster, Resident Lease Agreement, Service Plan, Resident Assessment, Preplacement Appraisal Information, Identification and Emergency Information, Physician’s Report, Resident Personal Property and Valuables, Admissions Orders, Resident Notes, Resident Care Plan, Unusual Incident/Injury Report for Resident 1(R1), and Staff schedule (dated 11/25/24-11/28/24). Substantiated Furthermore, the department conducted a tour of the facility and observed the residents to identify any signs of neglect, abuse or other immediate health and safety threats. During the course of the investigation, the following records were also received for R1: Hospice Records from Valley Oaks Hospice, Inc. (dated: 12/01/24-12/16/24) EMS records and 911 recording from Long Beach Fire Department, Death Certificate for R1 from Long Beach Department of Health and Human Services, Home Health Records for R1 from Royal Majesty Home Care, Medical Records from R1’s Gastroenterologist, SoCal Gastroenterology, Hospital Records from St. Mary Medical Center, and Medical Records from Provider 1st R1’s Primary Care Physician, Imaging Records for R1 from St. Mary Medical Center. On 10/15/25, the department requested a copy of the staff roster, resident roster, and the facility menu. The department conducted interviews with witness #1-Witness#15 (W1-W15), staff #1-staff#20 (S1-S20), and residents #2-#7 (R2-R7). The department was unable to interview R1, as R1 passed away on 12/06/24. The investigation revealed the following: Allegation: Staff did not provide adequate supervision to resident in care. It is being alleged that R1 sustained injuries resulting from facility neglect. The department reviewed records gathered during the investigation. Physician’s report dated 04/26/23 indicated that R1 is non-ambulatory, confused/disoriented, has sundowning behavior, and needs assistance with activities of daily living (ADLs). Preplacement Appraisal Information Dated 05/04/23 indicated that R1 was ambulatory was able to move in and out of bed or chair; able to move around facility without assistance from another person. It further notes that R1 requires special observation or night supervision due to confusion, forgetfulness, or wandering. Services Plan dated 05/09/23 indicated that R1 needs no assistance with transferring or mobility, but the care team is to monitor for changes in condition and conduct a reappraisal as appropriate. It was also noted that R1 would need ongoing support for disruptive sleep patterns. A review of the Resident Assessment dated 10/10/23 indicates that R1 needs assistance with observation & fall management. Resident’s Annual Assessment Form dated 07/11/24 indicated that staff were to conduct status checks on R1 2-3 times each shift. The department reviewed Facility body check forms which noted injuries on the following days: 11/07/2024 (bruise and swelling to left hand fingers) and 11/14/2024 (skin tear on left elbow). Facility Endorsement Notes note injuries on the following days: 11/04/2025 (bruising and swelling of left hand) and 11/25/2024 (rash on skin and bruises on left arm. Communication Log forms indicate that on 11/26/24 at 0536, R1 was found in their bedroom floor by a caregiver, after last being checked at 0300 hours. R1 was observed with two flesh wounds on each elbow and redness to the left side of their temple. The department received and reviewed Unusual Incident/Injury Report (UIR) dated 11/26/24. Per the incident report, on 11/26/24, at around 0536 hours, R1 sustained an unwitnessed fall. S8 observed R1 on the floor of their room near the sofa with flesh wounds on both elbows and redness to the left side of their head. R1’s sofa, recliner, and laundry basket had been moved and were not in their usual location. S8 notified S9 of the incident, who in turn called 911. R1 was then transported to St. Mary Medical Center. The department reviewed medical records from St. Mary’s Medical Center Long Beach dated 11/26/24–12/05/24. According to the records, R1 was admitted on 11/26/24 with a diagnosis of blunt head trauma, fracture of left wrist and an intra-ventricular hemorrhage (IVH). R1 was discharged on 12/05/24 with a diagnoses of blunt head trauma, multiple abrasions, and IVH. R1 was admitted to Mom & Dad’s House Cottage Facility and was receiving hospice services from Valley Oaks Hospice. The department received and reviewed Death Report dated 12/06/24 which stated that R1 died of cardiac arrest on 12/06/2024. The department conducted interviews with S1-S20. Of those interviewed, 7 out of 20 staff were aware that R1’s motion sensor was turned off or not operable, and 13 out of 20 staff said they did not know if R1’s motion sensor was turned off or not operable. An interview conducted with S1 revealed that at one point they were informed that staff members were turning off the sensors, so an in-service training was provided, and staff was informed not to turn off the sensors. Additionally, S1 confirmed R1’s prior falls in July and October 2023 and acknowledged that such incidents should have triggered a reassessment and care plan update, including checking blood pressure, which was never done. An interview conducted with S4 revealed that caregivers sometimes turned the sensor off to help preserve the batteries when R1 wasn’t in the room. An interview conducted with S5 revealed they would find the sensors off during their morning shift, and that they notified S1 about this issue, and an in service training was provided to all staff. Continued on LIC9099-C The department conducted interviews with R2-R7, and were unable to interview R1, as they passed away on 12/06/24. Of those interviewed, 6 out 6 residents did not know if anyone had fallen and sustained injuries resulting from facility neglect. 6 out of 6 residents said the facility provides them with the necessary care and supervision. Based on evidence gathered, interviews conducted, and records reviewed, the preponderance of evidence standard has been met, therefore the above allegation is found to be Substantiated. California Code of Regulations, Title 22, Division 6, and Chapter 8 are being cited on the attached LIC9099-D. Allegation: Staff did not report resident's incidents to resident's authorized representative. It is being alleged that staff rarely called a resident’s responsible party about incidents including bruises to the residents body. The department interviewed S1-S20, of those interviewed, 3 out of 20 staff corroborated the allegation. Staff added that doctors and family were not notified of R1's injuries or change in condition which included R1's eating habits and ability to ambulate. On 10/15/25, the department interviewed R2-R7, and were unable to interview R1, as they passed away on 12/06/24. Of those interviewed, 4 out 6 residents said they did not know if staff reported any incidents to their authorized representative, and 2 out of 6 residents said that staff does report any incidents to their authorized representative. The department conducted an interview with W1. Per W1, R1 had several falls leading up to their fall on 11/26/24. In that time period, facility did not advise them of any changes they would be making to prevent R1 from falling. W1 added that they were not informed of injuries R1 sustained in month on November 2024, they only found out about them because they observed the injuries themselves. The department conducted a review of records gathered during the investigation. A review of the Resident Assessment dated 10/10/23 indicates that R1 needs assistance with observation & fall management. Resident’s Annual Assessment Form dated 07/11/24 indicated that staff were to conduct status checks on R1 2-3 times each shift. Continued on LIC9099-C The department reviewed Facility body check forms which noted injuries on the following days: 11/07/2024 (bruise and swelling to left hand fingers), 11/12/24 (dry skin on left knee and lower leg, along with bruising to both elbows), and 11/14/2024 (skin tear on left elbow). Facility Endorsement Notes indicate injuries on the following days: 11/04/2025 (bruising and swelling of left hand) and 11/25/2024 (rash on skin and bruises on left arm. Communication Log forms indicate that on 11/04/24, R1 was observed with bruising and swelling to their left hand. On 11/15/24, it was noted that R1 was found in bed with an open skin tear on their left elbow. The department reviewed an email dated 11/21/24, from R1’s family member to S4 and S13. Email notes that R1’s family member picked up R1 from the facility on 11/20/24 and noticed their elbow was bandaged and their forearm very bruised. R1’s family member asked S4 and S13 if they knew what caused it because two weeks prior, R1’s hand was black and blue and very sore with no explanation. Additionally, R1’s family member said that if it was from a fall, they would need to know because R1’s has anemia and may be light-headed, so they would have to notify R1’s doctor. Based on evidence gathered, interviews conducted, and records reviewed, the preponderance of evidence standard has been met, therefore the above allegation is found to be Substantiated. California Code of Regulations, Title 22, Division 6, and Chapter 8 are being cited on the attached LIC9099-D. At this time, an enhanced civil penalty determination is pending in reference to Health & Safety Code 1569.49(e)(1)(A) “Serious Bodily Injury” as defined in Section 243 of the Penal Code that states, a serious physical condition, including, but not limited to, the following: loss of consciousness; concussion; bone fracture; protracted loss or impairment of any bodily member or organ; a wound requiring extensive suturing; and serious disfigurement. An exit interview was conducted, and a copy of this report was provided.the state’s words, verbatim · CDSS document, Nov 13, 2025 · control 11-AS-20241209124307

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87468.2(a)(4) · Plan of correction due date: Nov 7, 2025

87468.2 Additional Personal Rights of Residents in Privately Operated Facilities (a) In addition to the rights listed in Section 87468.1, Personal Rights of Residents in All Facilities, residents in privately operated residential care facilities for the elderly shall have all of the following personal rights: (4) To care, supervision, and services that meet their individual needs and are delivered by staff that are sufficient in numbers, qualifications, and competency to meet their needs. This requirement was not met as evidenced by: Based on interviews conducted and record review, the licensee did not comply with section cited above by: On 11/26/24, R1 sustained a fall in their bedroom resulting in wounds to their arms, hands, and a brain bleed. Additionally, staff were aware that R1’s motion sensor was turned off or not operable, which poses a health, safety, and personal rights risks to residents in care.the state’s words, verbatim · CDSS document, Nov 13, 2025

Plan of correction: POC cleared on 11/12/25. A staff sign in sheet for an in service training conducted on 11/06/25 titled "ABC's of Senior Living: Always be Considerate" was submitted to the department via email on 11/12/25.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.1(a)(8) · Plan of correction due date: Nov 20, 2025

87468.1 Personal Rights of Residents in All Facilities (a) Residents in all residential care facilities for the elderly shall have all of the following personal rights:(8) To have their representatives regularly informed by the licensee of activities related to care or services, including ongoing evaluations, as appropriate to their needs. This requirement was not met as evidenced by: Based on interviews conducted and record review, the licensee did not comply with section cited above by: Interview conducted revealed R1’s family was not notified of R1's injuries or change in condition which included R1's eating habits and ability to ambulate, which poses a health, safety, and personal rights risks to residents in care.the state’s words, verbatim · CDSS document, Nov 13, 2025

Plan of correction: POC cleared on 11/12/25. A staff sign in sheet for an in service training conducted on 11/06/25 titled "ABC's of Senior Living: Always be Considerate" was submitted to the department via email on 11/12/25.

Allegation investigated: Resident sustained multiple falls resulting in a fracture due to a lack of supervision Staff did not properly report incidents involving resident

On 11/07/2025, Licensing Program Analysts (LPA) Socorro Leandro conducted an unannounced subsequent complaint investigation visit to deliver findings. LPA met with Administrator, Robert Jakini and the purpose of the visit was explained. LPA was granted entry to the facility. Page 1 of 6 Substantiated The investigation consisted of the following: On 02/10/2025, the department requested and gathered Resident 1’s (R1) records. On 02/25/2025, the department interviewed Witness 5 (W5) and Witness 9 (W9). On 03/12/2025, the department interviewed Staff 1 (S1), Staff 2 (S2), Witness 10 (W10). The department interviewed/attempted to interview R1, Resident 11 (R11), Resident 19 (R19) and Resident 20 (R20). On 06/25/2025, the department interviewed W5 and Witness 11 (W11). On 10/16/2025, the department interviewed/attempted to interview residents, staff, and witnesses. The department interviewed/attempted to interview Resident 2 (R2) to Resident 18 (R18); R2 to Resident 10 (R10) were able to answer all questions; Resident 11 (R11) to Resident 12 (R12) were able to answer some questions; and Resident 13 (R13) to R18 were unable to answer questions. The department interviewed Staff 1 (S1) to Staff 5 (S5) and attempted to interview Staff 6 (S6). The department interviewed Witness 1 (W1) to W5 and attempted to interview W6 to Witness 14 (W14). Facility records were gathered and reviewed which consisted of Personnel Report dated 10/15/2025, Resident Roster, and Identification And Emergency Information records for R2 to R11. On 10/29/2025, the department interviewed/attempted to interview staff and witnesses. The department attempted to interview S6. The department interviewed W6 to Witness 8 (W8) and attempted to interview Witness 9 (W9) to W14. Page 2 of 6 The investigation revealed the following: Allegation: “Resident sustained multiple falls resulting in a fracture due to a lack of supervision”, it is being alleged that on 12/31/2024 R1 had unwitnessed falls due to lack of supervision which resulted in a hip fracture. A review of R1’s medical and facility records revealed that R1 was a known fall risk who required significant assistance with mobility and Activities of Daily Living (ADLs). According to R1’s Individual Service Plan dated 7/3/2024, R1 required extensive assistance with mobility and toileting to prevent falls, and staff were directed to encourage and ensure the use of assistive devices such as walkers or canes. The Physician’s Report dated 8/19/2024, documented that R1 was non-ambulatory, required total assistance and supervision, and needed assistance with toileting. Similarly, R1’s Preplacement Appraisal Information dated 8/24/2024, indicated that R1 had a wobbly gait, needed physical assistance from another person for stability while walking, and required toileting assistance. According to medical records from St. Mary Medical Center-Long Beach, R1 was admitted to the hospital on 12/31/2024 and diagnosed with right hip fracture. Video surveillance from 12/31/2024, showed the following: at 7:35:24 a.m., R1 was seen walking toward the bathroom without an assistive device and without staff assistance, while an unidentified staff member stood nearby, looking at their phone near the bathroom door. At 7:35:44 a.m., R1 entered the bathroom alone. The staff member did not follow R1 and remained in place, still looking at their phone. At 7:36:05 a.m., a thump was heard, followed by R1 calling out, “Ay, ay, ay…” Page 3 of 6 The staff member then approached and entered the bathroom at 7:36:08 a.m., where R1 could be heard saying, “Ay, ay, ay. I fell.” The staff member responded, “Oh my god, are you okay? You’re okay, you’re okay, honey.” At 8:00:42 a.m., video surveillance showed that R1’s walker was not within reach of the bed and that R1’s bedroom door was closed. At 8:00:44 a.m., R1 was observed getting out of bed, putting on slippers, and attempting to walk toward the walker. At 8:01:32 a.m., R1 fell onto the floor beside the bed and repeatedly called out, “Ay, ay, ay” for roughly two minutes. At 8:03:59 a.m., another staff member opened R1’s bedroom door, entered the room, and began assisting R1. Emergency personnel were later called, and R1 was transported to the hospital. Interviews conducted with staff members S1, S2, W5, and W9 confirmed that R1 was recognized by all four individuals as a fall risk who required frequent redirection and regular safety checks. Based on the evidence, on 12/31/2024, R1 did not receive the necessary assistance or care & supervision with mobility, transfers, and toileting as outlined in their care plan and medical documentation. The lack of appropriate supervision and failure to implement R1’s individualized care needs resulted in two consecutive falls on the same morning, ultimately leading to R1’s hospitalization and diagnosis of a hip fracture. Based on observations, interviews and record review(s), the preponderance of evidence standard has been met, therefore the above allegation(s) is found to be substantiated. California Code of Regulations, Title 22, Division 6 and Chapter 8 are being cited on the attached LIC 9099D. An immediate Civil Penalty of $500.00 is being assessed please see attached LIC421IM. Page 4 of 6 Allegation: “Staff did not properly report incidents involving resident”, it is being alleged that the facility did not follow reporting requirements for unusual incidents/injuries that occurred to R1. A review of R1’s records revealed that R1 was admitted to St. Mary Medical Center-Long Beach on 12/31/2024 and discharged on 01/03/2024 with a diagnosis of right hip fracture and urinary tract infection. Video surveillance from 12/31/2024, showed that at approximately 8:01:32 a.m., R1 fell onto the floor beside the bed and repeatedly called out, “Ay, ay, ay” for roughly two minutes. At approximately 8:03:59 a.m., another staff member opened R1’s bedroom door, entered the room, and began assisting R1. At approximately 8:14:15 a.m., ambulance sirens were heard in the background. At approximately 8:20:20 a.m., two firefighters enter the room. A firefighter indicates that they will be taking R1 to the hospital. Interviews conducted with S1, S2, W5, W9, and W10 confirmed that R1 sustained a fall in 12/2024 which resulted in a hip fracture and facility staff called 911. A review of the department’s records, R1’s records, and emails between the department and W5 revealed that the facility did not submit a written report of the incident that occurred to R1 on 12/31/2024 to the department. Furthermore, department has not received an Unusual Incident/Injury Report (UIR) regarding the incident of R1 on 12/31/2024. Based on observations, interviews and record reviews, the preponderance of evidence standard has been met, therefore the above allegation is found to be substantiated. California Code of Regulations, Title 22, Division 6 and Chapter 8 are being cited on the attached LIC 9099D. Page 5 of 6 At this time, an enhanced civil penalty determination is pending in reference to Health & Safety Code 1569.49(f)“Serious Bodily Injury” as defined in Section 243 of the Penal Code that states, a serious physical condition, including, but not limited to, the following: loss of consciousness; concussion; bone fracture; protracted loss or impairment of any bodily member or organ; a wound requiring extensive suturing; and serious disfigurement.” An exit interview conducted with Administrator Robert Jakini, appeal rights explained and a copy of this report along with the Civil Penalty Assessment Form LIC 421IM and appeal rights were provided. Page 6 of 6 The investigation consisted of the following: On 02/10/2025, the department requested and gathered Resident 1’s (R1) records. On 02/25/2025, the department interviewed Witness 5 (W5) and Witness 9 (W9). On 03/12/2025, the department interviewed Staff 1 (S1), Staff 2 (S2), Witness 10 (W10). The department interviewed/attempted to interview R1, Resident 11 (R11), Resident 19 (R19) and Resident 20 (R20). On 06/25/2025, the department interviewed W5 and Witness 11 (W11). On 10/16/2025, the department interviewed/attempted to interview residents, staff, and witnesses. The department interviewed/attempted to interview Resident 2 (R2) to Resident 18 (R18); R2 to Resident 10 (R10) were able to answer all questions; Resident 11 (R11) to Resident 12 (R12) were able to answer some questions; and Resident 13 (R13) to R18 were unable to answer questions. The department interviewed Staff 1 (S1) to Staff 5 (S5) and attempted to interview Staff 6 (S6). The department interviewed Witness 1 (W1) to W5 and attempted to interview W6 to Witness 14 (W14). Facility records were gathered and reviewed which consisted of Personnel Report dated 10/15/2025, Resident Roster, and Identification And Emergency Information records for R2 to R11. On 10/29/2025, the department interviewed/attempted to interview staff and witnesses. The department attempted to interview S6. The department interviewed W6 to Witness 8 (W8) and attempted to interview Witness 9 (W9) to W14. Page 2 of 6 The investigation revealed the following: Allegation: “Staff did not provide proper care to resident following hospital discharge”, it is being alleged that staff did not follow doctors order for Resident 1 following their hospital discharge on 01/03/2025. Interviews conducted with R2 to R12 revealed the following: 9 out of 11 residents denied the allegation and 2 out of 11 residents were unable to answer the questions. Interviews conducted with S1 to S5 revealed the following: 5 out of 5 staff denied the allegation. Interviews conducted with W1 to W9 revealed the following: 9 out of 9 witnesses denied the allegation. R1’s hospital discharge records dated 12/31/2024 to 01/03/2025 revealed the following: R1’s discharge plan included “regular diet” and “Discharge Activity as tolerated” signed by Medical Doctor on 01/03/2025. There are no records indicating that R1 did not follow the hospital discharge orders. R1’s hospital record of “Discharge Instructions Document” dated 12/31/2024 revealed the following: “General instructions” provided for “Urinary Tract Infection” and “Hip Fracture” and “Fall Prevention in the Home”; there is no documentation indicating that said instructions were not followed. 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. Page 3 of 6 Allegation: “Staff spoke inappropriately to resident”, it is being alleged that staff spoke inappropriately to R1. Interviews conducted with R2 to R12 revealed the following: 11 out of 11 residents denied the allegation. Interviews conducted with S1 to S5 revealed the following: 5 out of 5 staff denied the allegation. Interviews conducted with W1 to W8 revealed the following: 7 out of 8 witnesses denied the allegation and 1 out of 8 witnesses agreed with the allegation. Observations on 02/10/2025 and 10/16/2025 revealed the following: staff were observed treating residents with dignity and respect. Video surveillance dated 01/04/2025 at 22:40:43 did not indicate that staff spoke inappropriately to R1. Records reviewed of Unusual Incident/Injury Reports and Resident Notes: do not indicate that staff have spoken to residents inappropriately. 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. Page 4 of 6 Allegation: “Staff did not prevent a resident from physically assaulting another resident”, it is being alleged that staff did not prevent R1 from being physically assaulted by their roommate. Interviews conducted with R2 to R12 revealed the following: 11 out of 11 residents denied the allegation. Interviews conducted with S1 to S5 revealed the following: 5 out of 5 staff denied the allegation. Interviews conducted with W1 to W8 revealed the following: 8 out of 8 witnesses denied the allegation, moreover, witnesses indicated that staff separate residents that don’t like each other. Review of the video surveillance obtained of two incidents that occurred in R1’s room on 12/6/2024 at 14:29:53 and 12/13/2024 at 18:22:37 in which the R1 and their roommate had an altercation. When staff entered the room, the incidents were deescalated, staff did not witness physical altercations between residents, and staff were unaware of the full details of the incidents at both times. Staff did deescalate the situation, re-directed residents, and separate residents. Unusual Incident/Injury Report regarding physical altercation between R1 and their roommate dated 12/31/2024 revealed the following: the facility discussed residents moving into a different room with residents responsible person; R1’s responsible person did not want R1 to move to another room; staff had an in-service about monitoring residents and redirecting residents; staff were also directed to do frequent monitoring during night shift. 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. Page 5 of 6 Allegation: “Staff restrained resident”, it is being alleged that on 01/2025 (exact date unknown) a staff member restrained R1 to their bed by using a waist belt. Interviews conducted with R2 to R12 revealed the following: 10 out of 11 residents denied the allegation and 1 out of 11 residents were unable to answer the question. Interviews conducted with S1 to S5 revealed the following: 5 out of 5 staff denied the allegation, furthermore, staff indicated that they have not placed restraints on residents or seen staff restrain a resident. Interviews conducted with W1 to W8 revealed the following: 8 out of 8 witnesses denied the allegation, moreover, witnesses indicate that they have not seen/heard about staff restrain residents. R1’s records reviewed: there is no documentation or video surveillance footage indicating that staff restrained R1. 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. An exit interview was conducted, and a copy of this report was provided to Administrator Robert Jakini. Page 6 of 6the state’s words, verbatim · CDSS document, Nov 7, 2025 · control 11-AS-20250206165106

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87411(a) · Plan of correction due date: Nov 25, 2025

87411 Personnel Requirements - General (a) Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs. In facilities licensed for sixteen or more, sufficient support staff shall be employed to ensure provision of personal assistance and care as required in Section 87608, Postural Supports. Additional staff shall be employed as necessary to perform office work, cooking, house cleaning, laundering, and maintenance of buildings, equipment and grounds. The licensing agency may require any facility to provide additional staff whenever it determines through documentation that the needs of the particular residents, the extent of services provided, or the physical arrangements of the facility require such additional staff for the provision of adequate services. This requirement is not met as evidenced by: Based on observations, interviews and record review, on 12/31/2024 during morning time staff did not provide competent services necessary to meet R1’s needs in ensuring that R1 received provisions of personal assistance and care which resulted in R1 having 2 unwitnessed falls and sustaining a hip fracture, which posed a potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Nov 7, 2025

Plan of correction: The Administrator has agreed to re-read CCR87411, create a plan to be in compliance with CCR87411, and retrain staff on how to provide competent services necessary to meet residents’ needs while ensuring that staff provides personal assistance and care. Email proof of correction to Socorro.Leandro@dss.ca.gov

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87211(a)(1)(B) · Plan of correction due date: Nov 25, 2025

87211 Reporting Requirements (a) Each licensee shall furnish to the licensing agency such reports as the Department may require, including, but not limited to, the following: (1) A written report shall be submitted to the licensing agency and to the person responsible for the resident within seven days of the occurrence of any of the events specified in (A) through (D) below. This report shall include the resident's name, age, sex and date of admission; date and nature of event; attending physician's name, findings, and treatment, if any; and disposition of the case. (B) Any serious injury as determined by the attending physician and occurring while the resident is under facility supervision. This requirement is not met as evidenced by: Based on observations, interviews and record review, the facility did not submit a written report to the department of a fall incident that occurred to R1 on 12/31/2024, that resulted to R1 having a hip fracture. The department has yet to receive an Unusual Incident/Injury Report of said incident on 12/31/2024 which posed a potential health, safety or personal rights risk to persons in care.the state’s words, verbatim · CDSS document, Nov 7, 2025

Plan of correction: The Administrator has agreed to re-read CCR87211 Reporting Requirements, create a plan to be in compliance with CCR87211, and retrain staff on how to submit written reports to licensing. Email proof of correction to Socorro.Leandro@dss.ca.gov

Allegation investigated: Questionable death. Resident was handled in a rough manner by staff, resulting in bruises.

On 11/06/25, the department conducted a subsequent complaint visit to further investigate the above-mentioned allegations and deliver findings. The department met with Robert Jackini, Executive Director, and explained the reason for the visit. The department was granted access to the facility. The investigation consisted of the following: On 12/10/24, the department requested, reviewed and received the following: a copy of the staff roster, resident roster, Resident Lease Agreement, Service Plan, Resident Assessment, Preplacement Appraisal Information, Identification and Emergency Information, Physician’s Report, Resident Personal Property and Valuables, Admissions Orders, Resident Notes, Resident Care Plan, Unusual Incident/Injury Report for Resident 1(R1), and Staff schedule (dated 11/25/24-11/28/24). Furthermore, the department conducted a tour of the facility and observed the residents to identify any signs of neglect, abuse or other immediate health and safety threats. Unsubstantiated **This page is being amended due to confidentiality reasons. This supersedes the report delivered on 11/06/25.** During the course of the investigation, the following records were also received for R1: Hospice Records from Valley Oaks Hospice, Inc. (dated: 12/01/24-12/16/24) EMS records and 911 recording from Long Beach Fire Department, Death Certificate for R1 from Long Beach Department of Health and Human Services, Home Health Records for R1 from Royal Majesty Home Care, Medical Records from R1’s Gastroenterologist, SoCal Gastroenterology, Hospital Records from St. Mary Medical Center, and Medical Records from Provider 1st R1’s Primary Care Physician, Imaging Records for R1 from St. Mary Medical Center. On 10/15/25, the department requested a copy of the staff roster, resident roster, and the facility menu. The department conducted interviews with witness #1-Witness#15 (W1-W15), staff #1-staff#20 (S1-S20), and residents #2-#7 (R2-R7). The department was unable to interview R1, as R1 passed away on 12/06/24. The investigation revealed the following: Allegation: Questionable death. It is being alleged that on 11/26/24, R1 sustained a fall in their bedroom resulting in wounds to their arms, hands, and a brain bleed. The resident then passed away on 12/06/24. The department conducted interviews with S1-S20. Of those interviewed, 20 out of 20 staff could not corroborate with the allegation. The department reviewed records. Per Unusual Incident/Injury Report (UIR) dated 11/26/24, on 11/26/24, at around 0536 hours, R1 sustained an unwitnessed fall. S8 observed R1 on the floor of their room near the sofa with flesh wounds on both elbows and redness to the left side of their head. R1’s sofa, recliner, and laundry basket had been moved and were not in their usual location. S8 notified S9 of the incident, who in turn called 911. R1 was then transported to St. Mary Medical Center. According to medical records from St. Mary’s Medical Center Long Beach dated 11/26/24–12/05/24, R1 was admitted on 11/26/24 with a diagnosis of blunt head trauma, fracture of left wrist and an intra-ventricular hemorrhage (IVH). R1 was discharged on 12/05/24 with a diagnoses of blunt head trauma, multiple abrasions, and IVH. R1 was then admitted to Mom & Dad’s House Cottage Facility, and was receiving hospice services from Valley Oaks Hospice. R1 passed away on 12/06/24. Death Report dated 12/06/24 indicates that R1 died of cardiac arrest at Mom and Dad’s House Cottage on 12/06/24. Based on the information gathered, interviews conducted, and records reviewed, the Department found no 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: Resident was handled in a rough manner by staff, resulting in bruises. It is being alleged that a resident was forcefully moved by staff when experiencing sundowner syndrome causing bruising in resident. The department conducted interviews with S1-S20. Of those interviewed, 8 out of 20 staff denied the allegation. 6 out of 20 staff said they don’t know if R1 or any other residents were forcefully moved by staff when experiencing sundowner syndrome resulting in bruising. 6 out of 20 staff said they treat all residents with dignity and respect. The department interviewed R2-R7, and were unable to interview R1, as they passed away on 12/06/24. Of those interviewed, 6 out of 6 residents said they don’t know of any residents who were forcefully moved by staff resulting in bruises. 6 out of 6 residents said staff treat them with dignity and respect. Based on the information gathered, interviews conducted, and records reviewed, the Department found no 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. An exit interview was conducted, and a copy of this report was provided to Gericca Wright, Sales Director. During the course of the investigation, the following records were also received for Resident #1 (R1): Hospice Records from Valley Oaks Hospice, Inc. (dated: 12/01/24-12/16/24) EMS records and 911 recording from Long Beach Fire Department, Death Certificate for R1 from Long Beach Department of Health and Human Services, Home Health Records for R1 from Royal Majesty Home Care, Medical Records from R1’s Gastroenterologist, SoCal Gastroenterology, Hospital Records from St. Mary Medical Center, and Medical Records from Provider 1st, R1’s Primary Care Physician, Imaging Records for R1 from St. Mary Medical Center. On 10/15/25, the department requested a copy of the staff roster, resident roster, and the facility menu. The department conducted interviews with witness #1- Witness #15 (W1-W15), staff #1- staff #20 (S1-S20), and residents #2-#7 (R2-R7). The department was unable to interview R1, as R1 passed away on 12/06/24. The investigation revealed the following: Allegation: Staff did not provide adequate supervision to resident in care. It is being alleged that R1 sustained injuries resulting from facility neglect. The department reviewed records gathered during the investigation. Physician’s report dated 04/26/23 indicated that R1 is non-ambulatory, confused/disoriented, has sundowning behavior, and needs assistance with activities of daily living (ADLs). Preplacement Appraisal Information Dated 05/04/23 indicated that R1 was ambulatory was able to move in and out of bed or chair; able to move around facility without assistance from another person. It further notes that R1 requires special observation or night supervision due to confusion, forgetfulness, or wandering. Services Plan dated 05/09/23 indicated that R1 needs no assistance with transferring or mobility, but the care team is to monitor for changes in condition and conduct a reappraisal as appropriate. It was also noted that R1 would need ongoing support for disruptive sleep patterns. A review of the Resident Assessment dated 10/10/23 indicates that R1 needs assistance with observation & fall management. Resident’s Annual Assessment Form dated 07/11/24 indicated that staff were to conduct status checks on R1 2-3 times each shift. The department reviewed Facility body check forms which noted injuries on the following days: 11/07/2024 (bruise and swelling to left hand fingers) and 11/14/2024 (skin tear on left elbow). Facility Endorsement Notes note injuries on the following days: 11/04/2025 (bruising and swelling of left hand) and 11/25/2024 (rash on skin and bruises on left arm. Communication Log forms indicate that on 11/26/24 at 0536, R1 was found in their bedroom floor by a caregiver, after last being checked at 0300 hours. R1 was observed with two flesh wounds on each elbow and redness to the left side of their temple. Continued on LIC9099-C The department received and reviewed Unusual Incident/Injury Report (UIR) dated 11/26/24. Per the incident report, on 11/26/24, at around 0536 hours, R1 sustained an unwitnessed fall. S8 observed R1 on the floor of their room near the sofa with flesh wounds on both elbows and redness to the left side of their head. R1’s sofa, recliner, and laundry basket had been moved and were not in their usual location. S8 notified S9 of the incident, who in turn called 911. R1 was then transported to St. Mary Medical Center. The department reviewed medical records from St. Mary’s Medical Center Long Beach dated 11/26/24–12/05/24. According to the records, R1 was admitted on 11/26/24 with a diagnosis of blunt head trauma, fracture of left wrist and an intra-ventricular hemorrhage (IVH). R1 was discharged on 12/05/24 with a diagnoses of blunt head trauma, multiple abrasions, and IVH. R1 was admitted to Mom & Dad’s House Cottage Facility and was receiving hospice services from Valley Oaks Hospice. The department received and reviewed Death Report dated 12/06/24 which stated that R1 died of cardiac arrest on 12/06/2024. The department conducted interviews with S1-S20. Of those interviewed, 7 out of 20 staff were aware that R1’s motion sensor was turned off or not operable, and 13 out of 20 staff said they did not know if R1’s motion sensor was turned off or not operable. An interview conducted with S1 revealed that at one point they were informed that staff members were turning off the sensors, so an in-service training was provided, and staff was informed not to turn off the sensors. Additionally, S1 confirmed R1’s prior falls in July and October 2023 and acknowledged that such incidents should have triggered a reassessment and care plan update, including checking blood pressure, which was never done. An interview conducted with S4 revealed that caregivers sometimes turned the sensor off to help preserve the batteries when R1 wasn’t in the room. An interview conducted with S5 revealed they would find the sensors off during their morning shift, and that they notified S1 about this issue, and an in service training was provided to all staff. The department conducted interviews with R2-R7, and were unable to interview R1, as they passed away on 12/06/24. Of those interviewed, 6 out 6 residents did not know if anyone had fallen and sustained injuries resulting from facility neglect. 6 out of 6 residents said the facility provides them with the necessary care and supervision. Continued on LIC9099-C Based on evidence gathered, interviews conducted, and records reviewed, the preponderance of evidence standard has been met, therefore the above allegation is found to be Substantiated. California Code of Regulations, Title 22, Division 6, and Chapter 8 are being cited on the attached LIC9099-D. Allegation: Staff did not report resident's incidents to resident's authorized representative. It is being alleged that staff rarely called a resident’s responsible party about incidents including bruises to the residents body. The department interviewed S1-S20, of those interviewed, 3 out of 20 staff corroborated the allegation. Staff added that doctors and family were not notified of R1's injuries or change in condition which included R1's eating habits and ability to ambulate. On 10/15/25, the department interviewed R2-R7, and were unable to interview R1, as they passed away on 12/06/24. Of those interviewed, 4 out 6 residents said they did not know if staff reported any incidents to their authorized representative, and 2 out of 6 residents said that staff does report any incidents to their authorized representative. The department conducted an interview with W1. Per W1, R1 had several falls leading up to their fall on 11/26/24. In that time period, facility did not advise them of any changes they would be making to prevent R1 from falling. W1 added that they were not informed of injuries R1 sustained in month on November 2024, they only found out about them because they observed the injuries themselves. The department conducted a review of records gathered during the investigation. A review of the Resident Assessment dated 10/10/23 indicates that R1 needs assistance with observation & fall management. Resident’s Annual Assessment Form dated 07/11/24 indicated that staff were to conduct status checks on R1 2-3 times each shift. The department reviewed Facility body check forms which noted injuries on the following days: 11/07/2024 (bruise and swelling to left hand fingers), 11/12/24 (dry skin on left knee and lower leg, along with bruising to both elbows), and 11/14/2024 (skin tear on left elbow). Facility Endorsement Notes indicate injuries on the following days: 11/04/2025 (bruising and swelling of left hand) and 11/25/2024 (rash on skin and bruises on left arm. Communication Log forms indicate that on 11/04/24, R1 was observed with bruising and swelling to their left hand. On 11/15/24, it was noted that R1 was found in bed with an open skin tear on their left elbow. The department reviewed an email dated 11/21/24, from R1’s family member to S4 and S13. Email notes that R1’s family member picked up R1 from the facility on 11/20/24 and noticed their elbow was bandaged and their forearm very bruised. R1’s family member asked S4 and S13 if they knew what caused it because two weeks prior, R1’s hand was black and blue and very sore with no explanation. Additionally, R1’s family member said that if it was from a fall, they would need to know because R1’s has anemia and may be light-headed, so they would have to notify R1’s doctor. Based on evidence gathered, interviews conducted, and records reviewed, the preponderance of evidence standard has been met, therefore the above allegation is found to be Substantiated. California Code of Regulations, Title 22, Division 6, and Chapter 8 are being cited on the attached LIC9099-D. At this time, an enhanced civil penalty determination is pending in reference to Health & Safety Code 1569.49(e)(1)(A) “Serious Bodily Injury” as defined in Section 243 of the Penal Code that states, a serious physical condition, including, but not limited to, the following: loss of consciousness; concussion; bone fracture; protracted loss or impairment of any bodily member or organ; a wound requiring extensive suturing; and serious disfigurement. An exit interview was conducted, and a copy of this report was provided to Gericca Wright, Sales Director. .the state’s words, verbatim · CDSS document, Nov 6, 2025 · control 11-AS-20241209124307

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87468.2(a)(4) · Plan of correction due date: Nov 7, 2025

87468.2 Additional Personal Rights of Residents in Privately Operated Facilities (a) In addition to the rights listed in Section 87468.1, Personal Rights of Residents in All Facilities, residents in privately operated residential care facilities for the elderly shall have all of the following personal rights: (4) To care, supervision, and services that meet their individual needs and are delivered by staff that are sufficient in numbers, qualifications, and competency to meet their needs. This requirement was not met as evidenced by: Based on interviews conducted and record review, the licensee did not comply with section cited above by: On 11/26/24, R1 sustained injuries while in care. Based on interviews, 7 out of 20 staff were aware that R1’s motion sensor was turned off or not operable, which poses a health, safety, and personal rights risks to residents in care.the state’s words, verbatim · CDSS document, Nov 6, 2025

Plan of correction: Licensee shall develop a written Plan of Correction to ensure compliance with California Code of Regulations Title 22, Section 87468.2(a)(4). Written POC must be submitted to LPA Gonzalez by the POC due date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.1(a)(8) · Plan of correction due date: Nov 20, 2025

87468.1 Personal Rights of Residents in All Facilities (a) Residents in all residential care facilities for the elderly shall have all of the following personal rights:(8) To have their representatives regularly informed by the licensee of activities related to care or services, including ongoing evaluations, as appropriate to their needs. This requirement was not met as evidenced by: Based on interviews conducted and record review, the licensee did not comply with section cited above by: Interview conducted with S1 revealed that doctors and family were not notified of R1's injuries or change in condition which included R1's eating habits and ability to ambulate, which poses a health, safety, and personal rights risks to residents in care.the state’s words, verbatim · CDSS document, Nov 6, 2025

Plan of correction: Licensee shall develop a written Plan of Correction to ensure compliance with California Code of Regulations Title 22, Section 87468.1(a)(8). Written POC must be submitted to LPA Gonzalez by the POC due date.

Allegation investigated: Staff do not ensure residents receive bathing services in a timely manner. Staff lock resident out of their rooms.

On 11/04/25 Licensing Program Analysts (LPA) Villegas conducted a subsequent complaint visit regarding the allegations above. LPA met with Executive Director (S1) Robert Jakini as the purpose of today’s visit was explained. The investigation consisted of the following: On 10/24/25 LPA Villegas obtained copies of the staff and resident roster, shower schedule, and copies of the following documents for Resident #1 (R1): Emergency ID form, Admission agreement dated: 02/16/2024, Preplacement appraisal dated: 02/20/2024, Service plan dated:07/29/2025, Physicians report dated:04/23/2025, and communication logs dated: 03/2024- 10/2025. On 10/24/25 from 8:15am- 9:30 am Interviews were conducted with staff #1-9 (S1-S9), and from 9:30 am- 12:00 pm interviews were conducted with residents # 2 (R2-R8). On 11/04/25 LPA attempted to interview R1, however R1 did not wish to be interviewed. The investigation revealed the following: Allegation: Staff do not ensure residents receive bathing services in a timely manner. Unsubstantiated It is being alleges that the facility staff are not bathing resident in care according to care plan. On 10/24/25 from 8:15am- 9:30 am Interviews were conducted with S1-S9 regarding the allegation above. 9 of the 9 staff interviewed denied the allegation above, 6 of 9 staff stated that residents have baths 2-3 times a week, 3 of 9 staff stated residents have bathes according to their care plan. 9 of 9 staff interviewed stated that when a resident refuses to bathe, it is documented on facility notes. On 10/24/25 from 9:30 am- 12:00 pm interviews were conducted with R2-R8 regarding the allegation above. 3 of the 7 residents interviewed denied the allegation above, 4 of the 7 residents interviewed reported they do not require assistance with bathing. 7 of 7 residents reported they have not gone more than 2 days without bathing. On 11/04/25 LPA conducted a review of the facilities shower schedule as well as a review of R1's Preplacement appraisal dated: 02/20/2024, Service plan dated:07/29/2025, and Physicians report dated:04/23/2025. Per shower log, R1 is schedules to shower 3 times a week. Per Preplacement appraisal dated: 02/20/2024 R1 requires partial assistance with bathing, although R1 prefers to do so on R1's own. Per Service plan dated:07/29/2025, R1 requires assistance with bathing 3 times a week as scheduled. Additionally, service plans states R1 requires heavy reminders and encouragement's to shower, and female staff only is required. Physicians report dated:04/23/2025, R1 is unable to bathe self. On 11/04/25 LPA reviewed facility notes dated 07/09/25 and dated 07/20/25. Notes dated 07/09/25 R1 was observed shaking and out of her norm, staff did not feel comfortable providing shower due to shaking, family was informed that R1 would not be receiving shower. Notes dated 07/20/25 facility notes indicated R1 was shaking shaking while being showered and lost balance but did not experience a fall, family was notified that R1 would not have a shower in the evening. On 11/04/25 LPA attempted to interview R1, however R1 did not wish to be interviewed. Allegation: Staff lock resident out of their bedrooms. It is being alleged that facility staff lock all the doors from the outside of the residents bedrooms in the memory care wing. On 10/24/25 from 8:15am- 9:30 am Interviews were conducted with S1-S9 regarding the allegation above. 9 of the 9 staff interviewed denied the allegation above, 2 of the 9 staff interviewed stated that residents have locked their bedroom doors as it is their right to do so. On 10/24/25 from 9:30 am - 12:00 pm interviews were conducted with R2-R8 regarding the allegation above. 7 of 7 residents interviewed denied the allegation above, and reported having access to bedrooms at all times. On 11/04/25 LPA attempted to interview R1, however R1 did not wish to be interviewed. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated. Exit interview conducted, and a copy of this report was provided.the state’s words, verbatim · CDSS document, Nov 4, 2025 · control 11-AS-20251017153339

Allegation investigated: Staff do not ensure that resident has a sanitary drinking dish

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 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 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 reportthe state’s words, verbatim · CDSS document, Oct 31, 2025 · control 11-AS-20251024151343

Type of visit: Case Management - Incident

On 10/24/2025 at 8:35am, Licensing Program Analyst (LPA) Zina Brown conducted an unannounced Case Management - Incident visit at this facility. LPA met with Robert Jakini (Administrator) and explained the purpose of the visit to conduct a health and safety check to follow up on a reported incident to the department on October 22, 2025 in regarding personal rights. The incident report is in regards to personal right for Resident 2 (R2). Between the hours of 8:45am - 8:50am, LPA conducted a tour of the Resident 1 (R1) and Resident (R2) shared bedroom with Staff 1 (S1). LPA requested and obtained LIC 602 Physician's Report for Residential Care Facility for the Elderly for both Resident (R1) and Resident (R2). Due to insufficient time LPA has decided additional time is needed to complete the investigation. Exit interview conducted with Robert Jakini (Administrator) and a copy of this report was provided.the state’s words, verbatim · CDSS document, Oct 24, 2025

Type of visit: Required - 1 Year

On 10/24/2025 at 08:20am, Licensing Program Analysts (LPAs) Zina Brown and Lizeth Villegas conducted an unannounced visit to the above facility. The purpose of today’s visit was to conduct the one-year inspection. LPAs met with Robert Jakini (Administrator) and the purpose of the visit was discussed. Facility is licensed to serve 91 non-ambulatory residents of which 10 may be bedridden, delay egress observed to be functional in memory care units which are floors, 2-4. There are 32 residents are diagnosed with dementia, 53 residents receiving home health and 10 residents receiving hospice care services. None the clients have Restricted Health Care Conditions and none are utilizing postural supports or protective devices. The facility does not handle any of the residents’ money. The facility has a current administrator certificate (#7010468740) for Robert Jakini (Administrator) valid from 07/24/2025 - 07/23/2027. Administrator provided with upcoming annual fees info. The facility has liability insurance with (Ascot Insurance Company - NAIC # 23752) with an effective date as of (11/01/2024 - 11/05/2025 ) with each occurrence at $1,000,000 and general aggregate at $2,000,000 (policy # MAPL241000320203). LPA's Brown and Villegas conducted a records review of (8) resident records, (8) staff records, and the facility disaster plan. Facility disaster plan is observed to be current and in compliance with Title 22 regulations at the time of visit. LPA Villegas conducted a review of (8) Resident Medication Administration Records. There are 2 medication carts that are used. Report continues on LIC 809-C The facility is a 10 story building with eight (8) rooms on each floor, a basement, administrative offices on the first floor, rooftop patio. For the memory care, the facility is allowed to 13 beds and 13 residents. Also on the memory care floors #2 - #4 there are egress doors. LPA Villegas toured the resident bedrooms that had the required furniture, bed linens and closet/drawer space to accommodate each resident comfortably. Resident bathrooms were checked. Toilets and water faucets worked properly, grab bars were secure, shower was free of mold/mildew and a non-skid mat was in place, water temperature measured between (105 F.-120 F.). Pull cords were observed. Common areas were clean and clear of hazards; doorways were free of obstructions. Kitchen was checked and observed to be within Title 22 regulations. Perishable and non-perishable food supply was checked. All cleaning solutions, hazardous items, and medications were securely locked and inaccessible to residents. Smoke detectors were working properly, and fire extinguisher was fully charged. Carbon monoxide detector was operational. First Aid kit was available. Outside grounds were toured and no bodies of water were observed. Walkways around the home were clear of hazards. There are no security bars or weapons on the premises. LPA observed the following not in compliance: On 10/25/2025, LPA observed 2 medication discrepancies for Resident 6 (R6) and Resident (R7). According to the California Code of Regulations (Title 22, Division 6, Chapter 8), LPA did observe deficiencies, and citations were issued at this time. Exit interview was held and a copy of the Facility Evaluation Report with Appeal Rights were provided to Robert Jakini (Administrator)the state’s words, verbatim · CDSS document, Oct 24, 2025

Allegation investigated: Facility is in disrepair.

On 10/15/25, the department conducted a subsequent complaint visit to further investigate the above-mentioned allegations and deliver findings. The department met with Robert Jackini, Executive Director, and explained the reason for the visit. The department was granted access to the facility. The investigation consisted of the following: On 12/10/24, the department requested a copy of the staff roster, and resident roster. The department reviewed service records for resident #1 (R1) and collected copies of the following documents: Resident Lease Agreement, Service Plan, Resident Assessment, Preplacement Appraisal Information, Identification and Emergency Information, Physician’s Report, Resident Personal Property and Valuables, Admissions Orders, Resident Notes, Resident Care Plan, Unusual Incident/Injury Report, and Staff schedule (for the dates of 11/25/24-11/28/24). The department conducted interviews with witness #1 (W1) and staff #1 (S1). CONTINUED ON LIC9099-C Unsubstantiated Furthermore, the department conducted a tour of the facility and observed the residents to identify any signs of neglect, abuse or other immediate health and safety threats. On 12/12/24, the department conducted interviews with W1. On 12/13/24, the department conducted interviews with witness #2 (W2), S1. On 12/14/24, the department conducted interviews with W2. On 12/16/24, the department received Hospice Records from Valley Oaks Hospice, Inc. (dated: 12/01/24-12/16/24) for R1. On 12/19/24, the department received EMS records and 911 recording from Long Beach Fire Department. On 12/20/24, the department received the Death Certificate from R1 from Long Beach Department of Health and Human Services. On 12/24/24, the department conducted interviews with W2, and witness #3 (W3). On 12/26/24, the department conducted interviews with staff #2-#5 (S2-S5). On 12/17/24, the department conducted interviews with W1. On 12/31/24, the department conducted interviews with staff #6-S7 (S6-S7). On 01/06/25, the department conducted interviews with witness #4 (W4). On 01/07/25, the department conducted interviews with staff #8-#9 (S8-S9). On 01/09/25, the department conducted interviews with staff #10 (S10). On 01/13/25, the department received Home Health Records for R1 from Royal Majesty Home Care, Inc. On 01/14/25, the department conducted interviews with W1. On 01/15/25, the department received Medical Records from R1’s Gastroenterologist, SoCal Gastroenterology, Hospital Records from St. Mary Medical Center, and Medical Records from Provider 1st R1’s Primary Care Physician. On 01/28/25, the department conducted interviews with witness #5 (W5). On 01/31/25, the department conducted interviews with staff #11 (S11). On 02/03/25, the department conducted interviews with witness #6 (W6). On 02/04/25, the department conducted interviews with witness #7 (W7). On 02/06/25, the department conducted interviews with witness #8 (W8). On 02/10/25, the department conducted interviews with witness #9 (W9) and staff #12 (S12). On 02/11/25, the department conducted interviews with witness #10 (W10). On 02/12/25, the department conducted interviews with witness #11 (W11). On 02/14/25, the department conducted interviews with witness #12 (W12). On 02/19/25, the department conducted interviews with staff #13 (S13). On 02/21/25, the department conducted interviews with S1 and S4. On 02/25/25, the department conducted interviews with W1. On 02/28/25, the department conducted interviews with staff #14-#15 (S14-S15). On 03/07/25, the department received Imaging Records for R1 from St. Mary Medical Center. On 03/14/25, the department conducted interviews with W2. On 03/20/25, the department conducted interviews with witness #13 (W13). On 03/21/25, the department conducted interviews with witness #14-#15 (W14-W15). Continued on LIC9099- On 10/15/25, the department requested a copy of the staff roster, resident roster, and the facility menu. The department conducted interviews with staff #2 (S2), staff #16-#20 (S16-S20), and residents #2-#7 (R2- R7). The department was unable to interview R1, as R1 passed away. On 10/17/25, the department conducted a tour of the facility and inspected rooms #306, and #303. Allegation: Facility is in disrepair. It is being alleged that the facility has no hot water on the 3rd floor, including the kitchen, laundry and a residents room. On 10/15/25, the department conducted interview with S2 and staff #16-#20 (S16-S20)). Of those interviewed, 6 out of 6 staff denied the allegation. 6 out of 6 staff said they have not taken a resident to shower in another residents bathroom because there was no hot water in their bathroom. 5 out of 6 staff said they did not know if R1 was ever taken to another residents bathroom because there was no hot water in their bathroom, and 1 out of 6 staff said R1 was never taken to another residents bathroom because there was no hot water in their bathroom. On 10/15/25, the department interviewed R2-R7, and were unable to interview R1, as they passed away. Of those interviewed, 6 out 6 residents denied the allegation. 6 out of 6 residents said there is hot water running in their bathroom and through the whole facility. 6 out of 6 residents said they have never been taken to another residents bathroom to shower due to no hot water running in their bathroom. 6 out of 6 residents said they did not know of a resident being taken to another residents bathroom to shower due to no hot water running in their bathroom. On 12/10/24, the department conducted a tour of the facility, and inspected rooms #306, #305, #303, #308, laundry room, and the kitchen. During the tour and inspection, the department observed the facility to be clean and sanitary. The water temperature properly measured between 105. F and 120. F in all rooms inspected, including the laundry room, and kitchen. The department observed the facility to be in good repair. On 10/17/25, the department conducted another tour of the facility, and inspected rooms #306, and #303. During the tour and inspection, the department observed the facility to be clean and sanitary. The water temperature properly measured between 105. F and 120. F in all rooms inspected. The department observed the facility to be in good repair. Continued on LIC9099-C Based on the information gathered, interviews conducted, and records reviewed, the Department found no 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. An exit interview was conducted, and a copy of the report was provided to Robert Jakini, Executive Director.the state’s words, verbatim · CDSS document, Oct 17, 2025 · control 11-AS-20241209124307

The state marks this report as 7 pages; the online copy we transcribed has 4. You can request the full file from the county licensing office.

Allegation investigated: Staff engaged in an argument with a family member in front of the resident. Staff lock resident out of their room. Due to lack of supervision, resident defecated in the corner of the kitchen.

On 11/24/2025 at 11:00 am, Licensing Program Analyst (LPA) Zina Brown conducted a subsequent complaint visit at this facility to deliver findings. During today’s visit, LPA met with Robert Jakini (Executive Director) & explained the purpose of the visit. The investigation consisted of the following: An initial complaint visit was conducted by the Department on 08/11/2025 at 1:20pm, Licensing Program Analysts (LPAs) Zina Brown, Ernand Daubet, Lizeth Villegas and Licensing Program Manager (LPM) Janae Hammond conducted an unannounced initial complaint visit at this facility. On 08/11/2025, LPAs conducted interviews with Administrator (A1), Staff (S1-S2), & Residents (R1-R7) between the hours of 2:15 pm - 3:41 pm & on 10/02/2025, LPA continued to conducted interviews between the hours of 10:00am - 2:15pm, with Staff (S3 - S9) & Residents (R8-R11). On 08/11/2025, LPA requested copies of Resident Roster (received on 08/11/2025), Staff Roster (received 08/11/2025), and the following records for Resident 2 (R2): LIC 601 Identification & Emergency Information, LIC 602 Physician's Report, LIC 625 Appraisal/ Needs & Service, Incident Reports for R2, and Staff Memory Care Training. Unsubstantiated The investigation revealed the following: Allegation: Staff engaged in an argument with a family member in front of the resident. It was alleged that the Executive Director engaged in a continuation of an argument with a family member in front of residents. On 08/11/2025, LPA interviewed Administrator (A1) regarding the allegation. A1 denied the allegation. A1 stated in the common area of the facility, one of the residents’ family members entered wearing a body camera that recorded staff and residents, which is a violation of residents’ rights. On 08/11/2025 between the hours of 2:30pm – 3:50pm, and on 10/02/2025 between 10:00am – 2:12pm, LPA conducted interviews with 10 residents regarding the allegation. Ten (10) of ten (10) residents denied the allegation. All residents stated they did not hear or witness any arguments between staff and a family member on July 31, 2025. On 08/11/2025 between the hours of 2:15pm – 3:41pm, and on 10/02/2025 between 10:10am – 12:44pm, LPA conducted interviews with nine (9) staff members regarding the allegation. Three (3) of nine (9) staff denied the allegation, and six (6) of nine (9) staff were unaware of the incident. The six staff stated they did not recall or know of any incident occurring on July 31, 2025, while three were not on shift at the time of the incident. On 10/08/2025, LPA interviewed Witness 1 (W1) regarding the allegation. W1 stated that while in the great room with her mother, she heard a discussion involving differing opinions but did not hear any yelling or screaming. W1 stated she would have preferred that the discussion be held privately rather than in front of guests and residents. LPM Hammond interviewed Witness (W2) further stated that upon entering the facility with a body camera, Administrator (A1) observed W2, followed them throughout the building, and began yelling and screaming in front of residents and several family members, causing discomfort among both residents and their families. Report continues on LIC 9099-C On 10/15/2025 between the hours 09:00am - 09:15am conducted a record review and observed the following documents: On 08/02/2025, the department received a LIC 625: Unusual Incident/Injury Report (dated 07/31/2025) which stated R1's family member approached A1 with a body camera in the dining room on the third floor of memory care unit. A1 asked R1's family member to cease from filming as A1 did not consent to being recorded as well as its against policy and violates the resident's person rights. A1 made an attempt to de-escalate the situation by disengaging and contacting the Department of Social Service (DSS): Community Care Licensing (CCL). Based on information gathered through interviews and record reviews, there is not enough 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 UNSUBSTANTIATED. Allegation: Staff locked residents out of their rooms. It was alleged that there was a continuous practice of the facility locking residents out of their rooms. On 08/11/2025, LPA interviewed Administrator (A1) regarding the allegation. A1 denied the allegation and stated there were no circumstances in which residents were intentionally locked out of their rooms. On 08/11/2025 between the hours of 2:30 pm – 3:50 pm, and on 10/02/2025 between 10:00 am – 2:12 pm, LPA conducted interviews with 10 residents regarding the allegation. Ten (10) of ten (10) residents denied the allegation and stated they had never been locked out of their rooms by staff. On 08/11/2025 between the hours of 2:15 pm – 3:41 pm, and on 10/02/2025 between 10:10am– 12:44 pm, LPA conducted interviews with nine (9) staff regarding the allegation. Seven (7) of nine (9) staff denied the allegation, and two (2) did not confirm or deny it. The seven staff stated they were never instructed to lock residents out of their rooms, while the two were not present at the time of the alleged incident. Based on information gathered through interviews and record reviews, there is not enough 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 UNSUBSTANTIATED. Report continues on LIC 9099-C Allegation: Due to lack of supervision, a resident defecated in the corner of the kitchen. It was alleged that due to a lack of supervision, a resident was searching for a bathroom and ultimately defecated in the corner of the kitchen. On 08/11/2025, LPA interviewed Administrator (A1) regarding the allegation. A1 denied the allegation. A1 stated that the resident had an accident in the kitchen and was unaware of how to manage it. Two of the staff were present and redirected the resident to her room, assisted with cleaning and changing, and then returned her to the common area. A1 explained that such incidents are common in memory care and are not typically reported to licensing, as they are part of the disease process. A1 also stated there are no cameras in memory care or assisted living common areas, only in certain resident rooms. On 08/11/2025 between the hours of 2:30pm – 3:50pm, and on 10/02/2025 between 10:00 am – 2:12pm, LPA conducted interviews with 10 residents regarding the allegation. Ten (10) of ten (10) residents denied the allegation and stated they had not witnessed or heard about a resident defecating in the kitchen area. On 08/11/2025 between the hours of 2:15pm – 3:41pm, and on 10/02/2025 between 10:10am – 12:44pm, LPA conducted interviews with nine (9) staff regarding the allegation. Nine (9) of nine (9) staff were unaware of the allegation and stated they did not witness or have knowledge of a resident defecating in the kitchen area. On 10/15/2025 between the hours of 9:20 am - 9:30 am, LPA conducted a record review and observed the following documents: LIC 602 Physician’s Report for Residential Care Facilities for the Elderly (RCFE), Resident Assessment, and Community Logs for Resident 2 (R2), which show no history of bowel incontinence or incidents of defecation. Based on information gathered through interviews and record reviews, there is not enough 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 UNSUBSTANTIATED. Report continues on LIC 9099-C An exit interview was conducted with Robert Jakini, Administrator, and a copy of this report was provided.the state’s words, verbatim · CDSS document, Oct 15, 2025 · control 11-AS-20250804110955

Allegation investigated: Staff did not provide adequate food service to residents in care. Staff did not safeguard resident's personal items. Staff did not meet residents' incontinence needs.

On 10/15/25, the department conducted a subsequent complaint visit to further investigate the above-mentioned allegations and deliver findings. The department met with Robert Jackini, Executive Director, and explained the reason for the visit. The department was granted access to the facility. The investigation consisted of the following: On 12/10/24, the department requested a copy of the staff roster, and resident roster. The department reviewed service records for resident #1 (R1) and collected copies of the following documents: Resident Lease Agreement, Service Plan, Resident Assessment, Preplacement Appraisal Information, Identification and Emergency Information, Physician’s Report, Resident Personal Property and Valuables, Admissions Orders, Resident Notes, Resident Care Plan, Unusual Incident/Injury Report, and Staff schedule (for the dates of 11/25/24-11/28/24). The department conducted interviews with witness #1 (W1) and staff #1 (S1). CONTINUED ON LIC9099-C Unsubstantiated Furthermore, the department conducted a tour of the facility and observed the residents to identify any signs of neglect, abuse or other immediate health and safety threats. On 12/12/24, the department conducted interviews with W1. On 12/13/24, the department conducted interviews with witness #2 (W2), S1. On 12/14/24, the department conducted interviews with W2. On 12/16/24, the department received Hospice Records from Valley Oaks Hospice, Inc. (dated: 12/01/24-12/16/24) for R1. On 12/19/24, the department received EMS records and 911 recording from Long Beach Fire Department. On 12/20/24, the department received the Death Certificate from R1 from Long Beach Department of Health and Human Services. On 12/24/24, the department conducted interviews with W2, and witness #3 (W3). On 12/26/24, the department conducted interviews with staff #2-#5 (S2-S5). On 12/17/24, the department conducted interviews with W1. On 12/31/24, the department conducted interviews with staff #6-S7 (S6-S7). On 01/06/25, the department conducted interviews with witness #4 (W4). On 01/07/25, the department conducted interviews with staff #8-#9 (S8-S9). On 01/09/25, the department conducted interviews with staff #10 (S10). On 01/13/25, the department received Home Health Records for R1 from Royal Majesty Home Care, Inc. On 01/14/25, the department conducted interviews with W1. On 01/15/25, the department received Medical Records from R1’s Gastroenterologist, SoCal Gastroenterology, Hospital Records from St. Mary Medical Center, and Medical Records from Provider 1st R1’s Primary Care Physician. On 01/28/25, the department conducted interviews with witness #5 (W5). On 01/31/25, the department conducted interviews with staff #11 (S11). On 02/03/25, the department conducted interviews with witness #6 (W6). On 02/04/25, the department conducted interviews with witness #7 (W7). On 02/06/25, the department conducted interviews with witness #8 (W8). On 02/10/25, the department conducted interviews with witness #9 (W9) and staff #12 (S12). On 02/11/25, the department conducted interviews with witness #10 (W10). On 02/12/25, the department conducted interviews with witness #11 (W11). On 02/14/25, the department conducted interviews with witness #12 (W12). On 02/19/25, the department conducted interviews with staff #13 (S13). On 02/21/25, the department conducted interviews with S1 and S4. On 02/25/25, the department conducted interviews with W1. On 02/28/25, the department conducted interviews with staff #14-#15 (S14-S15). On 03/07/25, the department received Imaging Records for R1 from St. Mary Medical Center. On 03/14/25, the department conducted interviews with W2. On 03/20/25, the department conducted interviews with witness #13 (W13). On 03/21/25, the department conducted interviews with witness #14-#15 (W14-W15). On 10/15/25, the department requested a copy of the staff roster, resident roster, and the facility menu. The department conducted interviews with staff #2 (S2), staff #16-#20 (S16-S20), and residents #2-#7 (R2- R7). The department was unable to interview R1, as R1 passed away. Furthermore, the department conducted a tour of the facility. The investigation revealed the following: For the allegation: Staff did not provide adequate food service to residents in care. It is being alleged that the food is never cut up nor pureed for the residents that can’t manage a whole chicken breast or a sandwich they couldn’t hold. On 10/15/25, the department conducted interview with S2 and S16-S20. Of those interviewed, 6 out of 6 staff stated that residents are provided adequate food service based on their dietary needs or modified diets. 6 out of 6 staff stated there is enough caregivers to attend to residents during mealtimes. On 10/15/25, the department interviewed R2-R7, and were unable to interview R1, as they passed away. Of those interviewed, 6 out 6 residents denied the allegation. 6 out of 6 residents said they do not have a special diet, and they eat what they want. 6 out of 6 residents said that staff does cut up, and puree residents food. 6 out of 6 residents stated there is enough caregivers to attend to residents during mealtimes. During a review of records, the department observed two weeks of the facility menu. The menu offers a variety of meals throughout the day, such as breakfast, lunch, dinner, including protein, starch, vegetables, and fruits. A review the Staff Roster revealed that the facility has enough staff to meet the needs of the residents served. The department conducted a tour of the facility and observed residents consuming a balanced lunch, which included chicken noodle soup, with a side of fruit, juice, and water. The kitchen was inspected, during which the department observed a five-day supply of perishable food and a seven- day supply of nonperishable food items were noted. The kitchen appeared clean, and no health or safety concerns were observed during the visit. Based on the information gathered, interviews conducted, and records reviewed, the Department found no 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 did not safeguard resident's personal items. It is being alleged that three sets of bedding and towels were purchased prior to a resident moving into the facility, yet there were never any towels, including hand towels to wipe their hands on, and only one sheet on the residents bed. On 10/15/25, the department conducted interview with S2 and S16-S20. Of those interviewed, 6 out of 6 staff denied the allegation. 6 out of 6 staff said they are not aware of a resident missing bedding and towels. 6 out of 6 staff said that the facility provides the residents with basic bedding necessities. On 10/15/25, the department interviewed R2-R7, and were unable to interview R1, as they passed away. Of those interviewed, 6 out of 6 residents said they haven’t had an issue with any of their belongings missing. 6 out of 6 residents said that the facility provides them with basic bedding necessities. During a review of records, the department observed that R1’s Resident Personal/Property and Valuables form (signed/dated: 04/27/23) was blank and had no personal items listed. Based on the information gathered, interviews conducted, and records reviewed, the Department found no 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 did not meet residents' incontinence needs. It is being alleged that there is a lack of changing incontinence at the facility. On 10/15/25, the department conducted interview with S2 and S16-S20. Of those interviewed, 6 out of 6 staff denied the allegation. 6 out of 6 staff stated that residents are checked on at least every two hour or as needed, and depending on their needs. 6 out of 6 staff said residents are not left in soiled briefs for an extended period of time. On 10/15/25, the department interviewed R2-R7, and were unable to interview R1, as they passed away. Of those interviewed, 6 out of 6 residents said they do not require any assistance with toileting. 6 out of 6 residents said that staff check on them frequently. 6 out of 6 residents said they have not observed a resident left in soiled briefs for an extended period of time. Based on the information gathered, interviews conducted, and records reviewed, the Department found no 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. An exit interview was conducted, and a copy of the report was provided to Robert Jakini, Executive Director.the state’s words, verbatim · CDSS document, Oct 15, 2025 · control 11-AS-20241209124307

The state marks this report as 8 pages; the online copy we transcribed has 5. You can request the full file from the county licensing office.

Allegation investigated: Facility staff violated residents personal rights by not obtain consent for the use of GPS tracking devices.

On 10/02/2025, at 09:05 am, Licensing Program Analyst (LPA) Zina Brown conducted a subsequent complaint visit at this facility to deliver findings. During today’s visit, LPA met with Robert Jakini (Executive Director) & explained the purpose of the visit. The investigation consisted of the following: An initial complaint visit was conducted by the Department on 08/28/2025, LPAs conducted a tour of the common areas within the facility and interviews with Administrator (A1), Staff (S1-S8) & Residents (R1-R11) between the hours of 9:51 am - 11:36am. LPA requested copies of the Resident Roster (received on 08/28/2025), Staff Roster (received 08/28/2025), Tempo Worn Report (dated 08/21/2025 from 10:17am - 08/28/2025 - 10:17am), and the requested the resident records provided to the resident's responsible party. Report continues on LIC 9099-C Substantiated The investigation revealed the following: Allegation: Facility staff failed to provide resident responsible parties with all requested records. It was alleged that the resident responsible party request resident record from the facility and the facility failed to provide all requested records. On 08/28/2025, between the hours of 9:51am - 10:11am, LPA interviewed A1 denied the allegation, stating the facility provides requested resident records within 48 hours. Requests from responsible parties for R12 and R9 were fulfilled, all records were provided and acknowledged in writing, no records were withheld, and none were reported lost or misplaced. On 08/28/2025, between 9:18am - 2:17pm, LPA interviewed 8 staff regarding the allegation: 8 out of 8 denied the allegation. Of the 8 staff who denied the allegation: 5 staff stated not being involved in handling nor responding to request for records from family members or responsible parties while the other 3 staff stated yes to be involved in providing records by request. On 08/28/2025, between the hours of 10:20am - 11:18am, LPA interviewed 11 residents regarding the allegation: 7 out 11 residents denied the allegation. 3 out of 11 resident were unsure of the allegation. 1 out of 11 residents were unable to confirm nor deny the allegation. Of the 11 residents: 7 residents who denied the allegation stated yes the facility has given their records request for themselves and or by their family, while the 3 residents who stated being unsure and would imagine the facility did provide the records ask for by their family and or themselves. Also 1 resident could not answer and went off topic in regards to the allegation. On 10/01/2025 between the hours of 11:12pm - 12:00pm, LPA reviewed records and observed the following: The responsible party or designee signed and dated on 04/23/2025 receiving the description of records in-person were provided by the facility such as admission records (given on 04/23/2025), medical records such as physician orders, discharge paperwork, labs (given on 04/23/2025), care/service plan, medication list and outside provider forms. LPA reviewed the resident record and did not observe any documents that were not released as requested at the time of visit. Report continues on LIC 9099-C Based on information gathered, interviews, and record reviews, there is not enough 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. An exit interview was conducted with Robert Jakini (Executive Director) and a copy of the report was provided. The investigation revealed the following: Allegation: Facility staff violated residents personal rights by not obtain consent for the use of GPS tracking devices. It was alleged that a GPS tracking and monitoring device was placed on the resident body without consent, and without the consent of the resident's representative. On 8/28/2025, between 9:51am - 10:11am, LPA conducted an interview with the Administrator A1 regarding the allegation. A1 denied the allegation and clarified that the facility had installed emergency call devices specifically, (Care Predict pendants) designed to detect falls, not to function as GPS trackers. A1 stated that residents and their responsible parties were informed of the devices, and consent was documented in the Admission Agreement. While some residents may choose to decline the devices, staff and visitors are not required to wear them. A1 further explained that licensing approval was not sought, as the devices were considered a product update rather than a new service requiring regulatory review. On 08/28/2025, between the hours of 10:21am - 11:23pm, LPA interviewed 8 staff regarding the allegation: 4 out of 8 staff were unsure of the allegation and stated not having any knowledge of consent being obtained for the devices. 4 out of 8 staff did not confirm nor denied the allegation stated families were informed about the devices during the family meeting.' On 8/28/2025, between the hours of 10:20am -11:18am, LPA interviewed 11 residents regarding the allegation. 9 of the 11 residents confirmed the allegation. 1 of the 11 residents was unsure, stating they did not remember but might have signed something consenting to the use of the device. 1 of 11 residents was unable to confirm or deny the allegation and went off topic during the interview. Of the 9 residents who confirmed the allegation, all stated they did not recall signing any form of consent for wearing the device. On 09/25/2025, between the hours of 11:35am -11:45am, LPA interviewed Witness 1 (W1) regarding the allegation. W1 stated that the CarePredict devices are tracking tools used exclusively to monitor residents within the facility. W1 clarified that the devices do not record audio or listen to conversations. According to W1, the devices collect medical and behavioral data such as heart rate, location patterns, time spent in specific areas, wake times, and bathroom usage. Additionally, the devices track staff response times to resident alerts, which are monitored by the facility through a centralized dashboard. On 10/01/2025 between the hours of 11:06am - 11:11am and 10/02/2025 between the hours of 12:50pm -1:02pm, LPA conducted a records review and observed the following: Report of Tempo Worn Report (dated 08/21/2025 - 08/28/2025 at 10:17am) which is from the Care Predict dashboard which tracks the amount of hours the tempo is worn by the residents. Also, in the resident lease agreement for R9 (dated 08/24/2024), R10 (dated 10/29/2024), and R11 (dated 01/23/2024) it does not state the use of a pendant nor the use of the tempo worn tracker. On 10/01/2025 at 4:45pm, LPA conducted a review of Regency Palms Long Beach file located in the El Segundo Regional Office and did not observe any documentation that Community Care Licensing Division approved the use of Care Predict (watch-style device). 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 SUBSTANTIATED. California Code of Regulations (Title 22, Division 6, Chapter 8), the above-mentioned deficiency was observed, and citation issued (ref. LIC 9099D). An exit interview conducted with Robert Jakini (Executive Director) and a copy of this report was provided with the appeals rights.the state’s words, verbatim · CDSS document, Oct 2, 2025 · control 11-AS-20250822142304

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.2(a)(2) · Plan of correction due date: Nov 3, 2025

Additional Personal Rights of Residents in Privately Operated Facilities(a) In addition to the rights in Section 87468.1. . .elderly shall have all of the personal rights: (2) To have their records & personal information remain confidential & to approve release, except as authorized by law Based on observation, records review & interviews conducted, the licensee failed to ensure resident consented to the use of tempo worn device provided by Care Predict which tracks resident personal information (location, heart rate, etc.) which poses as a personal right risk to resident in care.the state’s words, verbatim · CDSS document, Oct 2, 2025

Plan of correction: The facility will obtain consent from the resident's responsible parties for the use of the tempo worn device provided by Care Predict and submit proof to the department by POC due date.

Allegation investigated: Staff does not provide adequate supervision resulting in resident physically abusing another resident(s). Staff is wrongfully evicting resident.

Read the state’s words on page 2 of the record →

Allegation investigated: Staff unlawfully evicted a resident.

Read the state’s words on page 2 of the record →

Allegation investigated: Staff are smoking marijuana while working at the facility. Staff are rough and rude with residents.

Read the state’s words on page 2 of the record →

Allegation investigated: Staff do not ensure that resident is adequately fed. Staff do not ensure that resident is hydrated.

Read the state’s words on page 2 of the record →

Allegation investigated: Staff do not ensure that resident is adequately fed. Staff do not ensure that resident is hydrated.

Read the state’s words on page 2 of the record →

Allegation investigated: Staff unlawfully evicted a resident.

Read the state’s words on page 2 of the record →

Allegation investigated: Staff mishandled a resident’s medications. Staff did not properly report incidents involving the residents.

Read the state’s words on page 2 of the record →

Allegation investigated: Signal system was made inaccessible to resident in care

Read the state’s words on page 2 of the record →

Allegation investigated: Staff did not ensure resident was allowed to have visitors. Staff verbally threatened residents personal representative to evict resident in care.

Read the state’s words on page 2 of the record →

Allegation investigated: Staff did not put a plan in place to ensure resident would not be physically attacked by another resident Staff did not intervene during a resident on resident attack

Read the state’s words on page 2 of the record →

Type of visit: Case Management - Deficiencies

Read the state’s words on page 2 of the record →

Allegation investigated: Facility elevators are in disrepair.

Read the state’s words on page 2 of the record →

Allegation investigated: Staff mishandled a resident’s medications. Staff did not properly report incidents involving the residents.

Read the state’s words on page 2 of the record →

Allegation investigated: Staff did not safeguard resident's personal belongings.

Read the state’s words on page 2 of the record →

Allegation investigated: Facility staff failed to reassess resident properly.

Read the state’s words on page 2 of the record →

Allegation investigated: Resident sustained unexplained injuries while in care.

Read the state’s words on page 2 of the record →

Allegation investigated: Staff are not taking universal precautions to ensure COVID is not spread.

Read the state’s words on page 2 of the record →

Allegation investigated: Resident not assisted with medications as prescribed.

Read the state’s words on page 2 of the record →

Allegation investigated: Illegal Eviction

Read the state’s words on page 2 of the record →

Allegation investigated: Staff did not prevent a resident from sustaining an unexplained injury.

Read the state’s words on page 2 of the record →

Type of visit: Office

Read the state’s words on page 2 of the record →

Allegation investigated: Resident not assisted with medications as prescribed.

Read the state’s words on page 2 of the record →

Allegation investigated: Staff did not provide adequate supervision to resident(s) in care.

Read the state’s words on page 2 of the record →

Allegation investigated: Staff retaliated against resident resulting in eviction. Illegal Eviction.

Read the state’s words on page 2 of the record →

Allegation investigated: Licensee initiated eviction process in retaliation against resident.

Read the state’s words on page 2 of the record →

Allegation investigated: Staff did not respond to residents’ requests for assistance in a timely manner.

Read the state’s words on page 2 of the record →

Allegation investigated: Questionable Death Staff did not ensure postural support were used as prescribed

Read the state’s words on page 2 of the record →

Type of visit: Case Management - Deficiencies

Read the state’s words on page 2 of the record →

Allegation investigated: Staff did not assist resident with care needs in a timely manner.

Read the state’s words on page 2 of the record →

Allegation investigated: Resident had multiple falls in care. Facility failled to report an incident.

Read the state’s words on page 2 of the record →

Allegation investigated: Licensee initiated eviction process in retaliation against resident.

Read the state’s words on page 2 of the record →

Type of visit: Case Management - Deficiencies

Read the state’s words on page 2 of the record →

Allegation investigated: Staff leaves resident soiled for an extended period of time.

Read the state’s words on page 2 of the record →

Allegation investigated: Staff did not provide medication assistance to resident in care Staff falsified resident's records

Read the state’s words on page 2 of the record →

Allegation investigated: Licensee does not maintain facility in good repair

Read the state’s words on page 2 of the record →

Type of visit: Case Management - Deficiencies

Read the state’s words on page 2 of the record →

Allegation investigated: Staff do not secure residents medications.

Read the state’s words on page 2 of the record →

Allegation investigated: Staff handled resident in a rough manner.

Read the state’s words on page 2 of the record →

Type of visit: Case Management - Deficiencies

Read the state’s words on page 2 of the record →

Allegation investigated: Staff did not adequately assist resident with incontinence care needs in a timely manner.

Read the state’s words on page 2 of the record →

Type of visit: Case Management - Deficiencies

Read the state’s words on page 2 of the record →

Allegation investigated: Staff did not administer medication to residents as prescribed.

Read the state’s words on page 2 of the record →

Allegation investigated: Staff neglect resulted in resident falling.

Read the state’s words on page 2 of the record →

Type of visit: Required - 1 Year

Read the state’s words on page 2 of the record →

Allegation investigated: Staff did not give resident medication Staff are not documenting medications properly

Read the state’s words on page 2 of the record →

Allegation investigated: Staff do not treat residents with respect Staff handel residents roughly

Read the state’s words on page 2 of the record →

Allegation investigated: Staff did not seek timely medical care for resident.

Read the state’s words on page 2 of the record →

Allegation investigated: Facility staff failed to safe guard resident's belonging.

Read the state’s words on page 2 of the record →

Allegation investigated: Facility failed to follow resident's advance health care directive Faciliy staff is falsifying records

Read the state’s words on page 2 of the record →

Allegation investigated: Facility failed to obtain resident’s representative admission agreement signature at the time of and as a condition of admission.

Read the state’s words on page 2 of the record →

Allegation investigated: Neglect/lack of care and supervision resulted in the resident falling multiple times and sustaining an injury while in care. Staff did not seek timely medical treatment for resident.

Read the state’s words on page 2 of the record →

Allegation investigated: Facility personnel are not sufficient in numbers at all times to prevent residents from falling. Facility personnel are not sufficient in numbers at all times to answer resident call buttons in a timely manner. Facility personnel are not sufficient in numbers at all times to meet resident needs for incontinence care. Facility personnel are not sufficient in numbers at all times to meet resident needs for showering.

Read the state’s words on page 2 of the record →

Allegation investigated: Staff neglect properly cleaning resident when providing incontient care. Staff are not following medical orders

Read the state’s words on page 2 of the record →