Regency Palms Long Beach

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.

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), Preplacement Appraisal Information (Dated: 9/16/2024 & 8/24/2024), Incident Reports (Dated: 3/13/2025 & 4/13/2025)... Report Continued on LIC9099-C Unsubstantiated Unauthorized Use Of Cameras Warning Notice (Dated: 05/08/2025), and Eviction Notice (Dated: 05/21/2025) were obtained 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 and observed that the facility is appropriately documenting any incidents that occur and reporting them to CCLD and all other parties concerned in the residents care. The department did not find any evidence that the facility failed to have proper staffing causing the residents to be unsupervised. Based on observation, 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. Report Continued on LIC9099-C 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 resident’s 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) and 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”. 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 appears to be in compliance with Title 22 regulations. Based on observations, 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, Sep 17, 2025 · control 11-AS-20250911232048

Allegation investigated: Staff unlawfully evicted a resident.

This report supersedes ; report dated on 08/20/2025. On 09/17/2025, at 00:00 am, Licensing Program Analyst (LPA) Zina Brown conducted a subsequent complaint visit at this facility to deliver findings. During today’s visit, at 8:57am, 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 07/01/2025 and interviews with Administrator (A1), Staff (S1-S4), Residents (R1-R2) and Witness (W1) between the hours of 9:30 am – 11:53am. LPA requested and reviewed the following documents: Resident Roster (received on 07/01/2025), Staff Roster (dated 06/17/2025), LIC 601 Identification and Emergency Information (for R1- dated 02/18/2024 and for R2 - dated 09/10/2024), LIC 602: Physician Report for RCFE (for R1 - dated 04/23/2025 & for R2 - dated 02/12/2025), LIC 603A: Preplacement Appraisal (for R1 - dated 02/20/2024 & for R2 - dated 09/16/2024), LIC 625: Appraisal Needs & Service, Admission Agreement (for R1 dated 02/16/2024 & for R2 dated 04/08/2025) & Medication Administration Record for R1 & R2 from 05/2025 - 06/2025. Unsubstantiated Allegation 1: Staff unlawfully evicted a resident. It is alleged that the facility is attempting to evict Resident 1 (R1) for the failure of to comply with general policies of the compliance and failure to; comply with state or local law. On 07/01/2025, between the hours of 9:00 am - 9:30 am, LPA interviewed A1 who denied the allegation and stated that an eviction notice was issued to R1 due to violating the facilities Admission Agreement. A1 further stated use of an unauthorized video surveillance devices with audio component as a contributing factor which is not allowed at facility as stated in the admission agreement which was signed by R1 on 08/26/2024. Between the hours of 11:43am - 11:50am, LPA interviewed 4 staff regarding the allegation: 4 of 4 staff denied the allegation. Between 11:48am - 11:53am. LPA attempted to interview R1 who refused to be interviewed in regard to the allegation . LPA reviewed records and observed the following: On 05/12/2025, the facility issued an eviction notice to R1 which stated the reason for the eviction was for violating 87224 Eviction Procedures of Title 22 Regulations section 87224(a)(3) “Failure of the resident to comply with general policies of the facility. Also, on 05/31/2025 via Personal Service, the 30-day Notice of Terminate provided additional with a timeline of R1 violating the Community's general polices. Based on review of the eviction notice it documents the use of video surveillance with an audio component being used which violates the facilities admission agreement. LPA reviewed R1 Resident Lease Agreement which states under the section 10. Miscellaneous: 10.9 Due to the privacy of residents, Residents will not have Nanny Cams in their apartment. LPA reviewed the eviction notice and confirmed it was sent to CCLD within 5 days of issuance and based on LPAs review of the notice it appears to be in compliance with Title 22 regulations. 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.the state’s words, verbatim · CDSS document, Sep 17, 2025 · control 11-AS-20250626131828

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

On 09/17/2025 at 8:25am, Licensing Program Analyst (LPA) Zina Brown conducted an initial unannounced complaint investigation for the allegations listed above. During today’s visit, at 8:57am, LPA met with Robert Jakini (Executive Director) and explained the purpose of the visit. The investigation consisted of the following: On 09/17/2025, LPA interviewed with Administrator (A1), Staff (S1-S10) and Residents (R1-R7) between the hours of 9:10am – 2:17pm. The department received the following documents: Resident Roster (received 09/17/2025), Staff Roster (dated 09/17/2025), LIC 501 Personnel Record (for S1 - dated 08/18/2023 and S10 - dated 08/21/2023), Staff Training (for S1 and S10), Counseling/Discilinary Notice (for S1 dated 08/29/2025 & 01/23/2024 and for S10 dated 11/23/2024 & 04/23/2024) Progress Notes for R1 (October 2024 - September 2025) and Drug and Alcohol Poilcy. Report continues on LIC 9099-C Unsubstantiated The investigation revealed the following: Allegation : Staff are smoking marijuana while working at the facility It was alleged that staff returned to the facility from their lunch break blowing smoke from a vape smelling like marijuana. On 09/17/2025 at 9:10 am, LPA interviewed A1. A1 who denied allegation statedtwo (2) staff members of the team confront the S10 and checked for any signs of impairment consistent with the use of marijuana or alcohol. S10 was also made to empty all of the contents of her pockets. No signs of intoxication were noted by either of the two (2) team members that addressed and interviewed R10. A1 states the the facility do not conduct random drug test. Between 9:18am - 2:17pm, LPA interviewed 10 staff regarding the allegation: 9 out 10 staff denied the allegation. 1 out 10 staff denied staff smoking on the facility premises, however some of the staff do smoke away from the facility grounds while on their break. Of the 9 staff who denied the allegation stated, not witnessing staff smoking nor smelling of marijuana upon returning from their breaks. Between 9:46am - 11:35am, LPA interviewed 7 residents: 7 out of 7 residents denied the allegation. Of the 7 residents who denied the allegation stated, not noticing any unusual smells like marijuana upon staff returning from being outside on their breaks. Between the hours of 1:00pm - 2:00pm, LPA reviewed records and observed the following: 10.1 Drug and Alcohol Policy - Being under the influence of alcohol, illegal drugs (as classified under federal, state, or local laws), or other impairing substance while on the job may post a serious health and safety risk to others and will not be tolerated. Prohibited Conduct: Regency Palms prohibits employees from engaging in the following activities when they are on duty or company business or on company premises (whether or not they are working): The use abuse or being under the influence of alcohol, illegal drugs or other impairing substances. While the use of marijuana has been legalized under some state laws for medicinal and/or recreational use, it remains an illegal drug under federal law. Regency Palms doesn't discriminate against employees solely on the basis of their lawful off-duty use of marijuana. You may not consume or be under the influence of marijuana while on duty or at work. If you have a valid prescription for medical marijuana, refer to the Company's Disability Accommodation policy for additional information. Based on interviews conducted an records reviewed there is no evidence to support the allegation, therefore the allegation is UNSUBSTANTIATED. Allegation : Staff are rough and rude with residents It was alleged that staff was being rough and rude to a resident. On 09/17/2025 at 9:10 am, LPA interviewed A1. A1 who denied allegation and stated if in the event of staff being rough and rude a body integrity check is conducted on the alleged victim. The facility would interview the perpetrator and take appropriate action to address the complaint such as reporting it to the ombudsman and LPA and removing the offender from the workplace pending investigation. Between 9:18am - 2:17pm, LPA interviewed 10 staff the regarding the allegation: 10 out 10 staff denied the allegation. Of the10 staff who denied the allegation stated the staff stated they have not witnessed other staff members being rough nor rude towards the residents. The staff stated being polite and respectful while providing safe daily care to the residents. Between 9:46am - 11:35am, LPA interviewed 7 residents: 7 out of 7 residents denied the allegation. Of the 7 residents who denied the allegation stated feeling safe and respect when staff take care of the residents. Also, the residents stated they have not experienced themselves being handled rough and being treated rudely by the staff nor have not witnessed any of the staff being rough and rude with other residents. Between the hours of 1:00pm - 2:00pm, LPA reviewed records and observed the following: For R1 progress notes, there is no evidence of staff being rough and rude to resident. Based on interviews conducted an records reviewed there is no evidence to support the allegation, therefore the allegation is UNSUBSTANTIATED. 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 state’s words, verbatim · CDSS document, Sep 17, 2025 · control 11-AS-20250908102010

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

***This report supersedes the original report delivered on 9/4/2025. On 9/9/2025, the LPA arrived at the facility to deliver the corrected 9099, providing clarification on the original report issued on 09/4//2025. *** Robert was called and stated that Nikki Tang-Medtech is authorized to sign the report. On 9/4/2025 at 8:11AM, Licensing Program Analyst (LPA) Bernadette Allen conducted an unannounced visit to deliver findings for the alleged allegations. LPA identified herself and met with Robert Jakini- Administrator who was informed of the purpose of the visit. The investigation consisted of the following: On 9/3/2025, LPA obtained the following documents: resident and Staff roster not dated, Resident 1(R1) Admission Agreement, Admissions Orders dated 12/5/2023, Welbe Heath Assessment dated 11/30/2023, Identification and Emergency Information dated 1/6/2024 Continued Unsubstantiated Face Sheet with updated service plan dated 7/29/2025, Physician’s Report dated 12/5/2023 and 4/23/2025. End of shift reports dated for the following dates 8/21/2025, 8/22/2025,8/23/2025, 8/29/2025 and 9/2/2025 for the AM shift. Acacia Hospice of Southern California service plan dated 8/5/2025. LPA also obtained the staff shift schedule for 8/23/2025 and LPA conducted interviews with Staff Members 1-9 (S1-S9), Residents 1-7 (R1-R7) and Witness 1 (W1). Allegation #1: Staff do not ensure that resident is adequately fed The investigation revealed the following: On September 3, 2025, at 10:00 AM, LPA Allen conducted interviews with Staff Members 1 - 9 (S1–S9) and 9 out of 9 staff members stated that residents are adequately fed daily, including the provision of liquids such as water, juice, and milk. Staff also reported that when a resident refuses to eat after three (3) attempts, a meal replacement is provided and documented on end of shift notes. LPA specifically inquired about Resident 1 (R1) and whether R1 was provided dinner on August 23, 2025, and 9 out of 9 staff members expressed confidence that dinner was provided to R1; however, none could confirm whether R1 consumed the meal. At 12:00 PM, LPA interviewed Residents 1 - 7 (R1–R7) and 6 out of 7 residents reported that they are provided meals daily, including beverages such as water and juice, and staff encourages them to drink water throughout the day. LPA attempted to interview R1 on three separate occasions; however, R1 was asleep each time. During the visit, LPA observed a clear cup of water with a straw on R1’s bedside, along with a green thermos that appeared to be full when picked up and in reach of the residents’ bed. On September 4, 2025, at 9:15 AM, LPA attempted another interview with R1. However, R1 was unable to stay on topic or engage in a clear conversation. During this time, LPA observed Staff Member 4 (S4) assisting R1 with eating oatmeal, drinking water, and consuming a bottled Starbucks Vanilla Frappuccino (cold brew). Continued LPA interviewed Witness 1 (W1), who stated Resident 1 (R1) was not provided a meal until approximately two hours after dinner was served to other residents, which typically occurs around 5:00–5:30 PM. When asked if R1 eventually received a meal, W1 confirmed yes, a peanut butter and jelly sandwich and some tuna which R1 wouldn’t eat and was given an ensure meal replacement. At 12:26 PM, LPA reviewed R1’s file, including physician reports dated April 23, 2025, and July 29, 2025, as well as the Acacia Hospice of Southern California service plan dated August 5, 2025. None of these documents indicated that R1 had experienced dehydration, weight loss or a special diet. LPA reviewed the end of shift reports dated 8/21/2025, 8/22/2025, 8/23/2025, 8/29/2025 and 9/2/2025 for the AM shift which does reflect that R1 had refused their breakfast and lunch but R1 was given and willing to drink a meal replacement (Ensure) and water along with notifying Medtech of missed meals. When LPA requested PM end of shift notes specifically for dinner on those same dates, the facility was unable to provide them. Allegation #2: Staff do not ensure that resident is hydrated The investigation revealed the following: On September 3, 2025, at 10:00 AM, LPA Allen interviewed Staff Members 1- 9 (S1–S9) and 9 out of 9 staff stated that residents are encouraged to drink water daily and reminded hourly. During the facility tour, staff pointed out water stations available to residents on floors 4, 5, and 6 and LPA observed residents drinking water. At 12:00 PM, LPA interviewed Residents 1 - 7 (R1–R7) and 6 out of 7 residents confirmed they are provided meals daily, including beverages such as water and juice, and that staff encourage them to drink water throughout the day. On 9/3/2025, LPA attempted to interview R1 on three separate occasions, During the visit, LPA observed a clear cup of water with a straw on R1’s bedside, along with a green thermos that appeared to be full when picked up and in reach for the resident’s bed. Continued On September 4, 2025, at 9:15 AM, LPA attempted another interview with R1. However, R1 was unable to stay on topic or engage in a clear conversation. During this time, LPA observed Staff Member 4 (S4) assisting R1 with eating oatmeal, drinking water, and consuming a bottled Starbucks Vanilla Frappuccino (cold brew). LPA also interviewed Witness 1 (W1), who expressed concerns about R1’s water intake and hydration. However, a review of end-of-shift notes dated August 21, 22, 23, 29, and September 2, 2025, reflects that R1 was provided with water and Ensure meal replacements on those dates. Additionally, LPA directly observed R1 drinking water and eating during the visit. LPA reviewed R1’s file, including physician reports dated April 23, 2025, and July 29, 2025, as well as the Acacia Hospice of Southern California service plan dated August 5, 2025. None of these documents indicated that R1 had experienced dehydration, weight loss or a special diet. Based on interviews, documents reviewed and observation during the investigation, 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 violations did or did not occur. An exit interview was conducted where this report was discussed and provided to Nikki Tang- Medtech at conclusion of the visit.the state’s words, verbatim · CDSS document, Sep 9, 2025 · control 11-AS-20250826110419

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

On 9/4/2025 at 8:11AM, Licensing Program Analyst (LPA) Bernadette Allen conducted an unannounced visit to deliver findings for the alleged allegations. LPA identified herself and met with Robert Jakini- Administrator who was informed of the purpose of the visit. The investigation consisted of the following: On 9/3/2025, LPA obtained the following documents: resident and Staff roster not dated, Resident 1(R1) Admission Agreement, Admissions Orders dated 12/5/2023,Welbe Heath Assessment dated 11/30/2023, Identification and Emergency Information dated 1/6/2024,Face Sheet with updated service plan dated 7/29/2025, Physician’s Report dated 12/5/2023, 4/23/2025 and end of shift reports dated for the following dates 8/21/2025, 8/22/2025,8/23/2025, 8/29/2025 and 9/2/2025 for the AM shift. Acacia Hospice of Southern California service plan dated 8/5/2025. LPA also obtained the staff shift schedule for 8/23/2025 as well as conducted interviews with staff members 1-9 (S1-S9), residents 1-7 (R1-R7) and Witness 1 (W1) Continued Unsubstantiated Allegation #1: Staff do not ensure that resident is adequately fed The investigation revealed the following: On September 3, 2025, at 10:00 AM, LPA Allen conducted interviews with Staff Members 1 - 9 (S1–S9). All 9 staff members stated that residents are adequately fed daily, including the provision of liquids such as water, juice, and milk. Staff also reported that when a resident refuses to eat after three (3) attempts, a meal replacement is provided. LPA specifically inquired about Resident 1 (R1) and whether R1 was provided dinner on August 23, 2025. All 9 staff members expressed confidence that dinner was provided to R1; however, none could confirm whether R1 actually consumed the meal. Staff Members 3 and 4 (S3–S4), who have worked directly with R1 but were not on duty on August 23, 2025, during the PM shift, reported that R1 has a history of refusing meals. They stated that after three (3) attempts to encourage eating, a meal replacement such as Ensure is typically offered. At 12:00 PM, LPA interviewed Residents 1- 7 (R1–R7). 6 out of 7 residents confirmed they are provided meals daily, including beverages such as water and juice, and that staff encourage them to drink water throughout the day. LPA attempted to interview R1 on three separate occasions; however, R1 was asleep each time. At 1:10 PM, LPA reviewed end-of-shift notes from the AM shift dated August 21, 22, 23, 29, and September 2, 2025. These notes indicated that R1 refused meals on each of those dates. However, a meal replacement was offered, and both the med tech and hospice nurse were informed of R1’s refusal to eat. When LPA requested PM shift notes specifically for dinner on those same dates, the facility was unable to provide them. continued LPA also interviewed Witness 1 (W1), who reported that R1 was not provided a meal but approximately two hours after dinner was served to other residents typically around 5:00 PM. W1 stated that this appeared to be an isolated oversight, though it was concerning. W1 added that R1 was eventually given a peanut butter and jelly sandwich and tuna salad. On September 4, 2025, at 9:15 AM, LPA attempted another interview with R1. However, R1 was unable to stay on topic or engage in a clear conversation. During this time, LPA observed Staff Member 4 (S4) assisting R1 with eating oatmeal, drinking water, and consuming a bottled Starbucks Vanilla Frappuccino (cold brew). At 12:26 PM, LPA reviewed R1’s file, including physician reports dated April 23, 2025, and July 29, 2025, as well as the Acacia Hospice of Southern California service plan dated August 5, 2025. None of these documents indicated that R1 had experienced dehydration or excessive weight loss. Allegation #2: Staff do not ensure that resident is hydrated The investigation revealed the following: On September 3, 2025, at 10:00 AM, LPA Allen interviewed Staff Members 1 through 9 (S1–S9). All staff stated that residents are encouraged to drink water daily and hourly. During the facility tour, staff pointed out water stations available to residents on floors 4, 5, and 6. At 12:00 PM, LPA interviewed Residents 1 through 7 (R1–R7). Six out of seven residents confirmed they are provided meals daily, including beverages such as water and juice, and that staff encourage them to drink water every hour throughout the day. LPA again attempted to interview R1 on three separate occasions, but R1 was asleep each time. Continued On September 4, 2025, at 9:15 AM, LPA made another attempt to interview R1. However, R1 was unable to stay on topic or engage in a coherent conversation. Despite this, LPA observed R1 being assisted by S4 while consuming oatmeal, water, and a bottled Starbucks Vanilla Frappuccino (cold brew). LPA also interviewed Witness 1 (W1), who expressed concerns about R1’s water intake and hydration. However, a review of end-of-shift notes dated August 21, 22, 23, 29, and September 2, 2025 confirmed that R1 was provided water on those dates. Additionally, LPA directly observed R1 drinking water during the visit. Based on interviews, documents reviewed and observation during the investigation, 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.the state’s words, verbatim · CDSS document, Sep 4, 2025 · control 11-AS-20250826110419

Allegation investigated: Staff unlawfully evicted a resident.

On 08/20/2025, at 11:45 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 07/01/2025 and interviews with Administrator (A1), Staff (S1-S4), Residents (R1-R2) and Witness (W1) between the hours of 9:30 am – 11:53am. LPA requested and reviewed the following documents: Resident Roster (received on 07/01/2025), Staff Roster (dated 06/17/2025), LIC 601 Identification and Emergency Information (for R1- dated 02/18/2024 and for R2 - dated 09/10/2024), LIC 602: Physician Report for RCFE (for R1 - dated 04/23/2025 & for R2 - dated 02/12/2025), LIC 603A: Preplacement Appraisal (for R1 - dated 02/20/2024 & for R2 - dated 09/16/2024), LIC 625: Appraisal Needs & Service, Admission Agreement (for R1 dated 02/16/2024 & for R2 dated 04/08/2025) & Medication Administration Record for R1 & R2 from 05/2025 - 06/2025. Unsubstantiated Allegation 1: Staff unlawfully evicted a resident. It is alleged that the facility is attempting to evict Resident 1 (R1) for the failure of to comply with general policies of the compliance and failure to; comply with state or local law. On 07/01/2025, between the hours of 9:00 am - 9:30 am, LPA interviewed A1 who denied the allegation and stated that an eviction notice was issued to R1 due to violating the facilities Admission Agreement. A1 further stated use of an unauthorized video surveillance devices with audio component as a contributing factor which is not allowed at facility as stated in the admission agreement which was signed by R1 on 08/26/2024. Between the hours of 11:43am - 11:50am, LPA interviewed 4 staff regarding the allegation: 4 of 4 staff denied the allegation. Between 11:48am - 11:53am. LPA attempted to interview R1 who refused to be interviewed in regard to the allegation . LPA reviewed records and observed the following: On 05/12/2025, the facility issued an eviction notice to R1 which stated the reason for the eviction was for violating 87224 Eviction Procedures of Title 22 Regulations section 87224(a)(3) “Failure of the resident to comply with general policies of the facility. Also, on 05/31/2025 via Personal Service, the 30-day Notice of Terminate provided additional with a timeline of R1 violating the Community's general polices. Based on review of the eviction notice it documents the use of video surveillance with an audio component being used which violates the facilities admission agreement. LPA reviewed R1's file and observed a reappraisal was conducted on 4/23/2025 by facility staff. LPA reviewed R1 Resident Lease Agreement which states under the section 10. Miscellaneous: 10.9 Due to the privacy of residents, Residents will not have Nanny Cams in their apartment. LPA reviewed the eviction notice and confirmed it was sent to CCLD within 5 days of issuance and based on LPAs review of the notice it appears to be in compliance with Title 22 regulations. 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.the state’s words, verbatim · CDSS document, Aug 20, 2025 · control 11-AS-20250626131828

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

This report supersedes ; report dated on 07/10/2025. On 08/20/2025, at 11:45am, 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) and explained the purpose of the visit. The investigation consisted of the following: An initial complaint visit was completed by the department on 06/25/2025. During the visit the department conducted interviews with Administrator (A1), Staff (S1-S6) and Residents (R1-R7) between the hours of 9:22 am – 11:47am. On 07/01/2025, the department conducted a subsequent complaint visit to gather additional information and conducted interviews with Staff (S7 - S8). Report continues on LIC 9099-C Substantiated The department obtained the following records from the facility: Resident Roster (received 06/25/2025), Staff Roster (dated 06/17/2025), LIC 601 Identification and Emergency Information (for R1) - dated 08/24/2024, LIC 602: Physician Report for RCFE (for R1) - dated 08/19/2024, LIC 603A: Preplacement Appraisal (for R1) - dated 08/24/2024, LIC 624: Unusual Incident/Injury Report - dated 04/13/2025 & faxed 07/01/2025, Staff Schedule (for April 2025), LIC 625: Client/Resident Personal Property and Valuables, Admission Agreement – (dated 08/24/2024), Service Plan (dated 04/24/2025) & Medication Administration Record April 2025 - June 2025. The investigation revealed the following: Allegation: Staff mishandled a resident’s medications. It is alleged that R1's medications had not been delivered to her as scheduled. On 06/25/2025, between 9:00 am - 9:30 am, LPA interviewed A1 who confirmed being aware of some medication errors. Between 9:22 am - 12:55 pm, LPA interviewed 8 staff: 3 of 8 confirmed the allegation, 3 denied the allegation, and 2 neither confirmed nor denied. Between 10:53 am - 11:47 am, LPA interviewed 7 residents: 3 out of 7 confirmed the allegation, 3 out of 7 denied the allegation, and 1 gave unclear responses. On 07/01/2025 between the hours of 11:45am - 1:30pm, the department reviewed R1 medications. The review revealed resident was prescribed medication Miradegron ER 25mg on 6/11/2025 and facility began administering the medication on 6/12/2025. According to the MAR resident was administered the medication daily from 6/12/2025-7/1/2025. The department counted the medication and noted as of 7/1/2025 20 out of 30 pills remained which there should have only been 11 pills remaining if the medication was given daily to R1. Also, LPAs observed the Medication Administration Record (MAR) did not match because the MedTech initial the MAR. 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). The investigation revealed the following: Allegation: Staff did not properly report incidents involving the residents. It is alleged that the facility did not report an alleged incident between R1 and another resident on April 13, 2025, to DSS, the Ombudsman, or law enforcement, as would be required by law. On 06/25/2025, between 9:00 am - 9:30 am, LPA interviewed A1 who confirmed the incident occurred and stated upon doing a reporting review, the incident was not reported to the Department and confirmed and provided the proof of incident being faxed on 07/01/2025 when initially the incident occurred on 04/13/2025 . Between 9:22 am - 12:07 pm, LPA interviewed 8 staff: 4 denied the allegation, and 3 was unsure of the allegation. Between 10:53 am - 11:47 am, LPA interviewed 7 residents: 1 out of 7 confirmed the allegation, 4 out of 7 denied the allegation, and 2 out of 7 were unsure of the allegation. LPA conducted a records reviewed for the incident that occurred on 04/13/2025 but noted no evidence that the incident was reported to DSS or the Ombudsman in a timely manner. 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). A copy of this report was provided with the appeals rights to Robert Jakini (Executive Director). Allegation: Staff unlawfully evicted a resident. It is alleged that the facility is attempting to evict Resident 1 (R1) and the eviction notice does not support that R1 engaged in incidents that would make it impossible to live with other residents. On 06/25/2025, between the hours of 9:00 am - 9:30 am, LPA interviewed A1 who denied the allegation and stated that an eviction notice was issued to R1 due to aggressive behaviors, which includes physical aggression toward staff and residents. A1 further stated use of unauthorized video surveillance devices with audio component as a contributing factors which is not allowed at facility as stated the admission agreement which was signed by R1 on 08/26/2024. Between the hours of 9:22 am - 12:07 pm, LPA interviewed 8 staff regarding the allegation: 5 of 8 staff denied the allegation, 3 out of 8 staff denied being aware the of any eviction notices. Between 10:53 am - 11:47 am, LPA interviewed residents #1-7, 7 out of 7 residents denied the allegation and 1 out of 7 residents gave unclear responses. LPA reviewed records and observed the following: an eviction notice was issued to R1 on 05/21/2025 which stated the reason for the eviction was for violating 87224 Eviction Procedures of Title 22 Regulations section 87224(a)(3) “Failure of the resident to comply with general policies of the facility. Said general policies must be in writing, must be for the purpose of making it possible for residents to live together and must be made part of the admission agreement”; 87224(a)(4) “If, after admission, it is determined that the resident has a need not previously identified and a reappraisal has been conducted pursuant to Section 87463, and the licensee and the person who performs the reappraisal believe that the facility is not appropriate for the resident.” Based on review of the eviction notice it documents incidents that occurred between R1 and facility staff and residents and documents the use of video surveillance with an audio component being used which violates the facilities admission agreement. LPA revied R1 file and observed a reappraisal was conducted on 4/23/2025 by facility staff. LPA reviewed R1 admission agreement which outlined the general policies of the facility identified in the eviction notice. LPA reviewed the eviction noticed and confirmed it was sent to CCLD within 5 days of issuance and based on LPAs review of the notice it appears to be in compliance with Title 22 regulations. 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. Allegation: Staff are retaliating against a resident. It is alleged that the proposed eviction is retaliatory. On 06/25/2025, between 9:00 am - 9:30 am, LPA interviewed A1 who denied the allegation and stated that staff are in-serviced regularly to ensure fair treatment and follow-up on family complaints, and that decisions are based on care needs, safety, and facility policy. Between 9:22 am - 12:07 pm, LPA interviewed 8 staff: 8 out of 8 denied the allegation. Between 10:53 am - 11:47 am, LPA interviewed 7 residents: 7 out of 7 denied the allegation. LPA did not observe any documentation or evidence supporting claims of retaliation. Based on the 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. No deficiencies were cited for the allegations above. An exit interview was conducted, and a copy of this report was provided to Robert Jakini (Executive Director).the state’s words, verbatim · CDSS document, Aug 20, 2025 · control 11-AS-20250619142057

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(a)(4) · Plan of correction due date: Aug 22, 2025

ncidental Medical and Dental Care (a) A plan for incidental medical & dental care shall be developed by each facility. The plan shall encourage routine medical & dental care & . . assistance in obtaining such care, by compliance with ...: (4) the licensee shall assist residents with self-administered medications as needed. This requirement was not met as evidence by. Based on observation & record review, staff failed to ensure medication for (R1) was not administered as per the doctor's order. This poses a potential health & safety risk to residents in care.the state’s words, verbatim · CDSS document, Aug 20, 2025

Plan of correction: The licensee will re-training and re-certify all Med-Tech on administering medication to all the residents. The licensee will also conduct daily audits for Medication Administration for the next 30 days. 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.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87211(a)(1)(D) · Plan of correction due date: Aug 27, 2025

Each licensee shall furnish to the licensing agency such reports... (1) A written report shall be submitted to the licensing agency...within seven days of the occurrence...(D) Any incident which threatens the welfare, safety or health of any resident... Based on conducted interviews & records review the licensee failed to report incidents that occurred on 04/13/2025 to licensing in accordance with Title 22 regulation. This poses a potential Health, Safety, or Personal Rights risk to persons in care.the state’s words, verbatim · CDSS document, Aug 20, 2025

Plan of correction: The facility will submit the LIC624 Unusual Incident/Injury Report to the Department of the incident that occurred on 04/13/2025. Also the facility will training all staff on reporting requirements per Title 22 regulation. 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: Signal system was made inaccessible to resident in care

On 08/06/2025, Licensing Program Analyst (LPA), Wendy Gibbs, conducted a complaint visit to the facility listed above. LPA met with Executive Director, Robert Jakini, and the purpose of today’s visit was explained. LPA was granted entry into the facility. The investigation consisted of the following: LPA inspected the facility, tested emergency pull cords, interviewed Staff S1-S7, interviewed Residents R1-R8, and received pertinent documentation to the investigation. The documents include a Staff Roster, Resident Roster, Pull Cord Stations testing log (06/11/2025), and Work Orders. The investigation revealed the following: Unsubstantiated Allegation: Signal System was made inaccessible to a resident in care The allegation alleges the string from a resident’s emergency pull cord had been cut and tied tightly around the button and that it was not able to be pulled. During the facility tour, LPA checked and tested the emergency pull cords in the following rooms 204A, 302B, 403A, 501A, 602A, 705, 805, and in a common area on the 7th floor. LPA observed the tested emergency pull cord stations were operational, and staff responded to each call within 7 minutes. During record review, LPA received and reviewed the Pull Cord Stations testing log dated 06/11/2025, that is conducted by S3 on a monthly basis. The log had no indication that the emergency pull cord station in the room in question was not working properly. LPA did observe room 203s pull cords were not operating properly and was repaired the same day it was tested. Additionally, LPA received and reviewed the Work Orders for the facility and observed on 07/30/2025, a work order was submitted for room 302B by S7 at the request of S3 for the need of a bed pull cord. During interviews with Staff S1-S7, were asked if residents emergency pull cords are operational, seven (7) out of seven (7), stated residents emergency pull cords in their rooms and restrooms are operational. During interviews with Residents R2-R8, were asked if their emergency pull cord in their room is functional, seven (7) out of seven (7) stated yes, their emergency pull cords are operational. Additionally, Residents R2-R8, were asked if there have been any issues with their emergency pull cord or their pendants, seven (7) out of seven (7) stated there have been no issues with their pendants. During the course of the investigation, LPA was unable to find evidence to support the allegation. Although the allegation 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 is unsubstantiated. During today’s visit, LPA did not observe or cite any deficiencies. An exit interview was conducted with Executive Director, Robert Jankini, and a copy of this report was provided.the state’s words, verbatim · CDSS document, Aug 6, 2025 · control 11-AS-20250728135646

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

On 07/24/25, at 09:30am, the department conducted a subsequent complaint visit to the facility and was greeted by Robert Jakini, Executive Director. The department explained the purpose of this visit is to gather information about the complaint, gather facility files, interview staff/residents, and deliver findings for the allegations mentioned above. The investigation consisted of the following: An initial complaint visit was completed by the department on 04/23/2025. A subsequent visit was completed by the department on 07/24/2025. The department investigated the allegations mentioned in this complaint; and conducted interviews with staff (S1-S4) and residents (R1-R8) from 10:00am-02:00pm. The department received the following: Resident Roster (No Date) Personnel Report (Dated: 7/23/2025), ID/Emergency Information (Dated: 08/24/2024), Resident Lease Agreement Dated:08/24/2024), Physicians Report (Dated: 08/19/2024), Resident Assessment (Dated: 04/24/2025), House Rules/Visiting Hours Document (Dated: 08/24/2024)..... Report Continued on LIC9099-C Unsubstantiated Preplacement Appraisal (Dated: 08/19/2024), Unauthorized Use Of Cameras Warning Notice (Dated: 05/08/2025), Notice of Unlawful Detainer (Dated: 07/03/2025), Service Plan (Dated: 04/24/2025), Facility/Resident Notes (Dated: 04/11/2025), and Eviction Notice (Dated: 05/21/2025) from the facility. The investigation revealed the following: Allegation #1- Staff did not ensure resident was allowed to have visitors. The details of the complaint alleged that a family member of a resident was denied visiting the resident. It was reported that the family member wanted to do a wellness check and called the police to enter the facility. On 7/24/25, from 10:00am-2:00pm, the department interviewed staff (S1-S4) and residents (R1-R8) regarding the allegation. 4 of 4 staff denied the allegation that Staff did not ensure resident was allowed to have visitors. All staff (S1-S4) interviewed stated that they have never denied anyone the right to visit a resident at the facility. All staff stated that visiting hours are Monday through Sunday from 9:00am through 07:00pm. Staff also stated that a family member of a resident (R1), who had installed unauthorized cameras in the resident’s room, called at 1:00am on 04/11/25, because the camera was not transmitting and wanted to come and see the resident. Staff stated that they explained visiting hours are from 9:00am-7:00pm, Monday through Sunday, and this was not an emergency. Subsequently, stated staff, the family member called the police, they came, and they let the police and family member into the facility to check on the resident, and the resident was asleep and in no danger. The department interviewed residents (R1-R8) about the allegation and 8 of 8 residents that were interviewed stated that they have not had a problem with visiting family and friends in the facility. The majority of residents interviewed stated that visiting hours are from 9am -7pm and it is posted in the facility at the front desk. The department reviewed the Resident Lease Agreement (Dated:08/24/2024) and House Rules/Visiting Hours Document (Dated: 08/24/2024) and observed that visiting hours are written in the lease agreement and in the house rules and it states that visiting hours are from 9am-7pm. Visiting hours are also posted at the front desk. Based on interviews and records reviewed, there is insufficient evidence to support the allegation that the Staff did not ensure resident was allowed to have visitors. 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 Continued on LIC9099-C Allegation #2- Staff verbally threatened residents’ personal representative to evict resident in care. The details of the complaint alleged that a staff member of the facility, threatened to evict a resident (R1) because of their family members conduct in trying to visit the resident after hours. On 7/24/25, from 10:00am-2:00pm, the department interviewed staff (S1-S4) and residents (R1-R8) regarding the allegation. 4 of 4 staff denied the allegation that Staff verbally threatened residents’ personal representative to evict resident in care. All staff (S1-S4) interviewed stated that at no time did anyone ever threaten to evict a resident (R1) because of a family members conduct in trying to visit a resident. Staff stated that a written warning was given to the resident and the residents representative because of unauthorized use of cameras in the resident’s room, which is a violation of Title 22 regulations for community care facilities without a prior waiver. Staff stated that three warnings were given before an eviction notice was issued because of the camera use and in no way had anything to do with a family members conduct in trying to visit a resident. The department interviewed residents (R1-R8) about the allegation and 8 of 8 residents that were interviewed stated that they have not been threatened with eviction because of a family members conduct. Additionally, residents that were interviewed stated that they have not had any issues with the facility not allowing them visitors during visiting hours. The Department reviewed the Unauthorized Use of Cameras Warning Notice (Dated: 05/08/2025) and the Resident Lease Agreement (Dated:08/24/2024) and 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. Based on interviews and records reviewed, there is insufficient evidence to support the allegation that the Staff verbally threatened residents’ personal representative to evict resident in care. 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. No deficiencies were cited. 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, Jul 24, 2025 · control 11-AS-20250414164237

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

On July 24, 2025, Licensing Program Analyst (LPA) Pamela Bunker conducted an initial visit to gather information regarding the above allegations. LPA met with Robert Jakina, Executive Director, and explained the purpose of the visit. LPA was granted entry to the facility. The investigation consisted of the following: On July 24, 2025, the following documents were reviewed and/or obtained as part of the investigation: Staff Roster (dated 07/24/2025), Resident Roster (dated 07/24/2025), Unusual Incident Report (dated 07/21/2025), Admission Agreement (dated 08/24/2024) Identification and Emergency Information (dated 08/24/2024), Physician’s Report (dated 08/19/2024), Medical Assessment (dated 04/01/2024), Medication Administration Records (MARs) (dated 08/23/2024-current), Appraisal & Needs and Services Plan (dated 08/23/2024), Functional Capability Assessment (dated 08/24/2024), Preplacement Appraisal Information (dated 08/24/2024), Personal Rights (dated 08/23/2024), Consent Forms (date 08/24/2024), Resident Assessment (dated 04/01/2024), House Rules (dated 08/23/2024) Safety Information (dated 08/23/2024), See continued LIC9099-C page 2 Unsubstantiated Continued LIC9099-C page 2 Facility Complaint and Grievance Policy (dated 08/23/2024) and Staff In-Service Training (dated 06/18/2024). On 07/24/2025, from 11:00 a.m. to 3:30 p.m., the Department interviewed staff members (S1-S3) and residents (R1-R2) regarding the complaint allegations. The Department also attempted to interview residents (R3-R7); however, they were non-verbal, spoke only limited words, and were unable to respond to any of the questions. Mr. Jakina and LPA Bunker toured the facility Memory Care Unit to observe and identify any signs of neglect, abuse, or other immediate health and safety threats. We did not observe any signs of neglect or abuse during today's visit. Investigation revealed the following. Allegation: Staff did not put a plan in place to ensure the resident would not be physically attacked by another resident It was alleged that the staff failed to put a plan in place to ensure the resident would not be physically attacked. On 07/24/2025, from 11:00 a.m. to 3:30 p.m., staff #1-3 (S1-S3) were interviewed and stated that the facility does have a dementia care plan in place, which was reviewed by the Department. S1 also confirmed that the facility enforces a zero-tolerance policy for negative behaviors, including physical aggression, and that house rules are in effect. 3 out of 3 staff members stated that residents sign an admission agreement acknowledging that physical aggression towards another resident is not permitted. 3 out of 3 staff members stated this was the first incident of aggressive behavior between the residents involved. 3 out of 3 staff members noted that the facility has a plan in place to ensure the residents are protected from being physically attacked by other residents. 3 out of 3 staff members stated that incidents between residents still may occur and that staff cannot prevent such incidents from happening. S1 stated on 07/21/2025, the facility self-reported the unusual incident report to Community Care Licensing and the Ombudsman office in a timely manner. On the same day, the Department received and reviewed the Unusual Incident Report. On 07/24/2025, from 11:00 a.m. to 3:30 p.m., Interviews were conducted with resident #1-2 (R1-R2), who stated that no physical attack occurred and denied the allegations. Resident #3-7 (R3-R7) were non-verbal, spoke only limited words, and were unable to answer any of the questions. See continued LIC9099-C page 3 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. Investigation Revealed the following Allegation: Staff did not intervene during a resident-on-resident attack On 07/24/2025, from 11:00 a.m. to 3:30 p.m., staff #1-3 (S1-S3) were interviewed and stated that on 07/21/2025, there was an altercation between two residents; however, neither resident was injured. The caregivers intervened, and the staff self-reported the incident within a couple of hours to Community Care Licensing and the Ombudsman's office on that same day. The residents' responsible parties were also contacted immediately. The department received an Unusual Incident Report dated 07/21/2025 regarding the complaint allegation. S1-S3 stated that staff are trained and receive ongoing training to help prevent incidents like this from occurring. On 07/24/2025, the Department requested and reviewed the Staff In-Service Training on Preventing, Recognizing, and Reporting Abuse dated 06/18/2024. 3 out of 3 staff members stated that appropriate precautions were taken by staff intervening, separating the residents, and redirecting them. S1-S3 confirmed that this was the resident's first instance of aggressive behavior between the residents involved. On 07/24/2025, from 11:00 a.m. to 3:30 p.m., Interviews were conducted with resident #1-2 (R1-R2), who stated that no physical attack occurred and denied the allegations. Resident #3-7 (R3-R7) were non-verbal, spoke only limited words, and were unable to answer any of the questions. 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 Jakina, Executive Director. An exit interview conductedthe state’s words, verbatim · CDSS document, Jul 24, 2025 · control 11-AS-20250721144928

Type of visit: Case Management - Deficiencies

On 07/14/2025 at 3:10pm, Licensing Program Analyst (LPA) Zina Brown conducted an unannounced case management - deficiencies visit and met with Robert Jakini (Administrator) and explained the purpose of the visit. On 06/19/2025, the Department received an complaint # 11-AS-20250619142057 of which two (2) of the allegations were SUBSTANTIATED. On 07/14/2025, civil penalties were assessed for the deficiencies cited on 07/10/2025 for complaint #11-AS-20250619142057 under the California Code of Regulation Title 22, Division 6, Chapter 8. See attached LIC 9099-D. An exit interview was conducted with Robert Jakini, Administrator and a copy of this report was provided with appeal rights.the state’s words, verbatim · CDSS document, Jul 14, 2025

Allegation investigated: Facility elevators are in disrepair.

On 07/10/2025, at 11:45 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: On 07/01/2025, an initial complaint visit was conducted by the Department. On that day, LPAs Brown and Iniguez conducted a health and safety check of the facility. LPAs obtained and reviewed the following documents: Resident Roster dated: 7/1/25, Staff Roster dated: 6/17/25. On 07/10/2025, between the hours of 2:05pm - 2:51pm interviews were conducted with Regional Director (A1), Staff (S1-S6) & Residents (R1-R6). Report continues on LIC 9099-C Unsubstantiated The investigation revealed the following: Allegation: Facility elevators are in disrepair. It is alleged that the facility elevators was in despair and residents are unable to use facility elevators. On 07/10/2025, between the hours of 2:50pm - 2:51pm, LPA interviewed A1 who denied the allegation and stated that on 07/01/2025, the elevator company was notified immediately once the facility discovered that the elevators were not working. A1 stated the former Administrator notified the Department about the small passenger elevator no longer moving on both floors and the elevator company came out to the facility to fix the elevator. A1 also mentioned that the former Administrator come into the facility at approximately 5am on 07/01/2025 to assist staff with serving breakfast to the residents. The staff used the stairs to get to and from each floor to attend to the residents as needed. On 07/10/2025, between 2:11pm - 2:51pm, LPA interviewed 6 staff: 6 out of 6 denied the allegation. 3 of the 6 staff stated that the elevator was repaired the same day on on 07/10/2025 and 5 out the 6 staff confirmed that the residents and the families of the resident were notified. On 07/10/2025, between 2:05pm - 2:44pm, LPA interviewed 7 residents: 2 out of 7 denied the allegation and 5 out of 7 were unaware of the allegation. The residents stated they and their families were informed about the elevator not working on 07/01/2025, while other residents had no idea, couldn't answer and or were not affected because they don't leave the floor were they resided so therefore they don't use the elevator. On 07/01/2025, LPAs Brown & Inguiez conducted a health and safety visit and observed on the elevator was repaired at approximately around 1pm. LPAs used the facility elevator conducted interviews with the staff and the residents. On 07/01/2025, LPA conducted a records review and observed the following: the Department received the LIC 624: Unusual Incident/Injury Report via fax which stated the small passenger elevator was no longer moving on both floors. Report continues on LIC 9099-C. Based on the 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. No deficiencies were cited for the allegations above. An exit interview was conducted, and a copy of this report was provided to Robert Jakini (Executive Director).the state’s words, verbatim · CDSS document, Jul 10, 2025 · control 11-AS-20250701095115

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

On 07/10/2025, at 11:45am, 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) and explained the purpose of the visit. The investigation consisted of the following: An initial complaint visit was completed by the department on 06/25/2025. During the visit the department conducted interviews with Administrator (A1), Staff (S1-S6) and Residents (R1-R8) between the hours of 9:22 am – 11:47am. On 07/01/2025, the department conducted a subsequent complaint visit to gather additional information and conducted interviews with Staff (S7 - S8). Report continues on LIC 9099-C Substantiated The department obtained the following records from the facility: Resident Roster (received 06/25/2025), Staff Roster (dated 06/17/2025), LIC 601 Identification and Emergency Information (for R1) - dated 08/24/2024, LIC 602: Physician Report for RCFE (for R1) - dated 08/19/2024, LIC 603A: Preplacement Appraisal (for R1) - dated 08/24/2024, LIC 624: Unusual Incident/Injury Report - dated 04/13/2025 & faxed 07/01/2025, Staff Schedule (for April 2025), LIC 625: Client/Resident Personal Property and Valuables, Admission Agreement – (dated 08/24/2024), Service Plan (dated 04/24/2025) & Medication Administration Record April 2025 - June 2025. The investigation revealed the following: Allegation 2: Staff mishandled a resident’s medications. It is alleged that R1's medications had not been delivered to her as scheduled. On 06/25/2025, between 9:00 am - 9:30 am, LPA interviewed A1 who confirmed being aware of some medication errors. Between 9:22 am - 12:55 pm, LPA interviewed 8 staff: 3 of 8 confirmed the allegation, 3 denied the allegation, and 2 neither confirmed nor denied. Between 10:53 am - 11:47 am, LPA interviewed 7 residents: 3 out of 7 confirmed the allegation, 3 out of 7 denied the allegation, and 1 gave unclear responses. On 07/01/2025 between the hours of 11:45am - 1:30pm, the department reviewed R1 medications. The review revealed resident was prescribed medication Miradegron ER 25mg on 6/11/2025 and facility began administering the medication on 6/12/2025. According to the MAR resident was administered the medication daily from 6/12/2025-7/1/2025. The department counted the medication and noted as of 7/1/2025 20 out of 30 pills remained which there should have only been 11 pills remaining if the medication was given daily to R1. Also, LPAs observed the Medication Administration Record (MAR) did not match because the MedTech initial the MAR. 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). Report continues on LIC 9099-C. The investigation revealed the following: Allegation 3: Staff did not properly report incidents involving the residents. It is alleged that the facility did not report an alleged incident between R1 and another resident on April 13, 2025, to DSS, the Ombudsman, or law enforcement, as would be required by law. On 06/25/2025, between 9:00 am - 9:30 am, LPA interviewed A1 who confirmed the incident occurred and stated upon doing a reporting review, the incident was not reported to the Department and confirmed and provided the proof of incident being faxed on 07/01/2025 when initially the incident occurred on 04/13/2025 . Between 9:22 am - 12:07 pm, LPA interviewed 8 staff: 4 denied the allegation, and 3 was unsure of the allegation. Between 10:53 am - 11:47 am, LPA interviewed 7 residents: 1 out of 7 confirmed the allegation, 4 out of 7 denied the allegation, and 2 out of 7 were unsure of the allegation. LPA conducted a records reviewed for the incident that occurred on 04/13/2025 but noted no evidence that the incident was reported to DSS or the Ombudsman in a timely manner. 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). A copy of this report was provided with the appeals rights to Robert Jakini (Executive Director). The investigation revealed the following: Allegation 1: Staff unlawfully evicted a resident. It is alleged that the facility is attempting to evict Resident 1 (R1) and the eviction notice does not support that R1 engaged in incidents that would make it impossible to live with other residents. On 06/25/2025, between the hours of 9:00 am - 9:30 am, LPA interviewed A1 who denied the allegation and stated that an eviction notice was issued to R1 due to aggressive behaviors, which includes physical aggression toward staff and residents. A1 further stated use of unauthorized video surveillance devices with audio component as a contributing factors which is not allowed at facility as stated the admission agreement which was signed by R1 on 08/26/2024. Between the hours of 9:22 am - 12:07 pm, LPA interviewed 8 staff regarding the allegation: 5 of 8 staff denied the allegation, 3 out of 8 staff denied being aware the of any eviction notices. Between 10:53 am - 11:47 am, LPA interviewed residents #1-7, 7 out of 8 residents denied the allegation and 1 out of 7 residents gave unclear responses. LPA reviewed records and observed the following: an eviction notice was issued to R1 on 05/21/2025 which stated the reason for the eviction was for violating 87224 Eviction Procedures of Title 22 Regulations section 87224(a)(3) “Failure of the resident to comply with general policies of the facility. Said general policies must be in writing, must be for the purpose of making it possible for residents to live together and must be made part of the admission agreement”; 87224(a)(4) “If, after admission, it is determined that the resident has a need not previously identified and a reappraisal has been conducted pursuant to Section 87463, and the licensee and the person who performs the reappraisal believe that the facility is not appropriate for the resident.” Based on review of the eviction notice it documents incidents that occurred between R1 and facility staff and residents and documents the use of video surveillance with an audio component being used which violates the facilities admission agreement. LPA revied R1 file and observed a reappraisal was conducted on 4/23/2025 by facility staff. LPA reviewed R1 admission agreement which outlined the general policies of the facility identified in the eviction notice. LPA reviewed the eviction noticed and confirmed it was sent to CCLD within 5 days of issuance and based on LPAs review of the notice it appears to be in compliance with Title 22 regulations. 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. Report continues on LIC 9099-C Allegation 4: Staff are retaliating against a resident. It is alleged that the proposed eviction is retaliatory. On 06/25/2025, between 9:00 am - 9:30 am, LPA interviewed A1 who denied the allegation and stated that staff are in-serviced regularly to ensure fair treatment and follow-up on family complaints, and that decisions are based on care needs, safety, and facility policy. Between 9:22 am - 12:07 pm, LPA interviewed 8 staff: 8 out of 8 denied the allegation. Between 10:53 am - 11:47 am, LPA interviewed 7 residents: 7 out of 7 denied the allegation. LPA did not observe any documentation or evidence supporting claims of retaliation. Based on the 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. No deficiencies were cited for the allegations above. An exit interview was conducted, and a copy of this report was provided to Robert Jakini (Executive Director).the state’s words, verbatim · CDSS document, Jul 10, 2025 · control 11-AS-20250619142057

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(a)(4) · Plan of correction due date: Jul 12, 2025

Incidental Medical and Dental Care (a) A plan for incidental medical & dental care shall be developed by each facility. The plan shall encourage routine medical & dental care & . . assistance in obtaining such care, by compliance with ...: (4) the licensee shall assist residents with self-administered medications as needed. This requirement was not met as evidence by. Based on observation & record review, staff failed to ensure medication for (R1) was not administered as per the doctor's order. This poses a potential health & safety risk to residents in care.the state’s words, verbatim · CDSS document, Jul 10, 2025

Plan of correction: The licensee will re-training and re-certify all Med-Tech on administering medication to all the residents. The licensee will also conduct daily audits for Medication Administration for the next 30 days. 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.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87211(a)(1)(D) · Plan of correction due date: Jul 17, 2025

Reporting Requirements (a) Each licensee shall furnish to the licensing agency such reports... (1) A written report shall be submitted to the licensing agency...within seven days of the occurrence...(D) Any incident which threatens the welfare, safety or health of any resident... Based on conducted interviews & records review the licensee failed to report incidents that occurred on 04/13/2025 to licensing in accordance with Title 22 regulation. This poses a potential Health, Safety, or Personal Rights risk to persons in care.the state’s words, verbatim · CDSS document, Jul 10, 2025

Plan of correction: The facility will submit the LIC624 Unusual Incident/Injury Report to the Department of the incident that occured on 04/13/2025. Also the facility will training all staff on reporting requirements perTitle 22 regulation. 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 did not safeguard resident's personal belongings.

On 07/10/2025, Licensing Program Analyst (LPA), Wendy Gibbs, conducted an unannounced subsequent Complaint Visit to the facility listed above. LPA met with Executive Director, Fabiola Marciano, and the purpose of today’s visit was explained. LPA was granted entry into the facility. The investigation consisted of the following: During the initial visit conducted on 06/26/2025, LPA toured the facility, interviewed Staff S1-S11, interviewed Residents R2 and R3, and received documents pertinent to the investigation. The following documents were received and reviewed Staff Roster, Resident Roster, Resident Identification and Emergency Information (dated 08/24/2024), Physician’s Report (dated 08/19/2024), Admission Orders (date 08/22/2024), Resident Lease Agreement (dated 08/24/2024), Resident Packet (dated 08/23/2024), Client/Resident Personal Property and Valuables (dated 08/24/2025), Resident’s Copy of Health and Safety Code Sections: 1569.152, 1569.153, and 1569.154 (dated 08/24/2024), and staff In-Service (dated 06/17/2025) During today’s visit LPA interviewed Residents R1, R4-R8. The investigation revealed the following: Unsubstantiated Allegation: Staff did not safeguard resident’s personal belongings The allegation alleges the facility staff lost a resident's belonging. During record review, LPA received and reviewed the facility’s House Rules, signed and dated by R1’s Responsible Party on 08/23/2024, that states under Administration Department number 7. Management is not responsible for lost or stolen items (refer to Theft and Loss Policy included in the Resident Paperwork). LPA received and reviewed Theft and Loss Policy, signed and dated by R1’s Responsible Party on 08/23/2024, that states “Residents are encouraged to complete a personal property inventory when they move-in. We ask residents to keep this form updated as items are removed or added to the apartment.” Additionally, the Theft and Loss Policy states “Management is not responsible for the loss or theft of valuable from your apartment.” LPA received and reviewed Resident Personal Property and Valuables (LIC621), signed and dated by R1’s Responsible Party on 08/24/2024, declining to track personal property for R1. LPA received and reviewed the Health and Safety Code Section 1569.152, 1569.153, and 1569.154 Residential Care Facilities for the Elderly form, signed and dated by R1’s Responsible Party on 08/24/2025, that states in Sec. 3 Section 1569.153 of the Health and Safety Code “(d) …The facility shall not be liable for items which have not been requested to be included in the inventory or for items which have been deleted from the inventory.” During interviews with Staff S1-S11, were asked if they were made aware of R1 having a bedrail, eleven (11) out of eleven (11) stated yes they were aware R1 had a bedrail brought in. Additionally, Staff S1-S11 were asked if the family requested to have the bedrail added to the Resident Personal Property and Valuables (LIC621) form, eleven (11) out of eleven (11) stated to their knowledge the bedrail was not requested to be included on the form. During interviews with Residents R1-R8, were asked if they had any personal items go missing, seven (7) out of eight (8) stated they have had no items missing and if they did have an item missing caregivers help to locate the item During the course of the investigation, LPA was unable to find evidence to support the allegation. Although the allegation 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 is unsubstantiated. During today's visit, LPA did not observe or cite any deficiencies. An exit interview was conducted with Regional Director, Lisa To, and a copy of this report was provided.the state’s words, verbatim · CDSS document, Jul 10, 2025 · control 11-AS-20250619171348

Allegation investigated: Facility staff failed to reassess resident properly.

On 7/1/2025 at approximately 9:30 AM, LPA Alfonso Iniguez conducted an unannounced complaint visit. LPA Iniguez met with Monique Avila/Wellness Director. LPA Iniguez explained the purpose of this visit. Investigation Consisted of: LPA conducted the following interviews: Staff Interviews (S#1). LPA obtained and reviewed the following documents: Resident Roster dated: 7/1/25, Staff Roster dated: 6/17/25, Copy of (R#1)’s Physician’s Report for the Residential Care Facilities for the Elderly (RCFE) dated: 6/17/2025, Copy of (R#1) Service Plan dated:4/23/25. Evaluation Report continues LIC 9099-C Unsubstantiated Investigation Revealed the Following: Allegation: Facility staff failed to reassess resident properly The details of the complaint alleged that facility staff failed to reassess (R#1) properly. On July 1, 2025, at approximately 10:00 AM, during a records review, LPA Iniguez observed that (R#1) had a copy of their Physician's Report for the Residential Care Facilities for the Elderly (RCFE), specifically the LIC 602A form, dated June 17, 2025. Additionally, LPA Iniguez found that the LIC 602A form was completed and signed by (R#1)'s primary care physician (W#1), not by (S#1). In contrast, (S#1) completed the service plan for (R#1) dated April 23, 2025, but it was not signed by (R#1)’s Power of Attorney (POA). On July 1, 2025, at approximately 2:00 PM, during interviews with facility staff (S#1), she stated that she did not complete (R#1)’s medical assessment or LIC 602A. Additionally, (S#1) stated that she only completed (R#1)’s care plan for the facility. During this investigation, LPA did not find sufficient evident to support the above-mentioned allegation(s). Based on the evidence gathered, interviews conducted, and records reviewed, the preponderance of evidence standard has been met; therefore, the above-mentioned allegation(s) are found to be UNSUBSTANTIATED. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur. An exit interview was conducted, and a copy of the Complaint Report was given to Monique Avila/Wellness Director.the state’s words, verbatim · CDSS document, Jul 1, 2025 · control 11-AS-20250630143653

Allegation investigated: Resident sustained unexplained injuries while in care.

On 06/25/25 Licensing Program Analyst (LPA) Villegas conducted a subsequent complaint visit regarding the allegation(s) above. LPA met with as the purpose of today’s visit was explained. The investigation consisted of the following: On 05/28/25 LPA Villegas obtained copies of the staff and resident roster, and copies of the following documents for Resident #1 (R1) face sheet, admission agreement dated: 10/29/2024, Preplacement appraisal dated 09/16/2024, assessment dated 07/30/2024, individual service plan dated: 07/30/2024, Physicians report dated: 09/09/2024, fall risk notice dated 09/26/2024, current physicians orders, medication administration records from April 2025-May 2025, and resident notes. On 06/04/24 from 10:15am- 11:23am LPA conducted interviews with resident#2-7 (R2-R7), LPA unable to interview R1 as R1 is on isolation. On 06/04/25 and 06/13/25 LPA conducted interviews with staff #1-5 (S1-S5). On 06/4/25 from 12:55pm-1:45pm LPA conducted a records review. On 06/25/25 LPA attempted to interview R1, on 06/25/25 conducted a tour of the facility. Unsubstantiated LPA conducted a records review. The investigation revealed the following: Allegation: Resident sustained unexplained injuries while in care. It Is being alleged that resident in care has bruising on both arms. On 06/04/24 from 10:15am- 11:23am LPA conducted interviews with R2-R7 regarding the allegation above, 6 of 6 residents interviewed denied the allegation above and reported feeling safe when being assisted by staff. On 06/04/25 and 06/13/25 LPA conducted interviews with S1-S5 regarding the allegation above, 5 of 5 staff interviewed denied the allegation above. Per 5 of 5 staff interviewed, body checks are conducted daily and any bruising or change in condition is communicated to both Primary Care Physicians and families. On 06/03/25 LPA conducted interview with responsible party for R1, per responsible party there are no current safety concerns as responsible party has been in communication with both the facility and Primary Care Physician about the bruising. Responsible party also reported being aware that R1 has scratched and cause harm to self. On 06/23/25 LPA conducted a review of R1’s file, resident notes dated 05/25/25, 05/26/25, 05/22/25, and 05/18/25 indicated that R1 has been fixated on arms, rubbing arms with friction and picking arms causing bruising. On 05/04/25 primary care physician faxed an order for re-evaluation and adjust medications due to physical aggression. On 06/25/25 LPA attempted to interview R1, R1 was sleeping at the time of visit. 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, Jun 25, 2025 · control 11-AS-20250527101835

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

On 06/24/25 at 12:50 pm Licensing Program Analyst (LPA) Villegas conducted a subsequent complaint visit regarding the allegation(s) above. LPA met with Wellness Director Monique Avila as the purpose of today’s visit was explained. The investigation consisted of the following: On 06/04/25 LPA Villegas obtained copies of the staff and resident roster, facility infection control plan, emergency disaster plan,Covid-19 mitigation plan, unusual incident reports submitted to CCLD regarding covid-19 cases, email communication with Long Beach Health Department, email communication with residents and families dated 5/28/25, 5/30/25, and 6/2/25 and copy of in-service held on 5/28/25 for covid response and infection control. LPA obtained copies of the following documents for Resident #1 (R1) face sheet dated 2/18/24, physicians report dated 4/23/25, pre-appraisal dated 2/20/24, resident assessment dated 2/10/24, and documented communication with POA. On 06/04/24 from 10:15am- 11:22am LPA conducted interviews with resident#2-7 (R2-R7), LPA unable to interview R1 as R1 is on isolation. On 06/04/25 and 06/13/25 LPA conducted interviews with staff #1-5 (S1-S5). Unsubstantiated During interviews LPA observed staff and residents to be wearing face mask. On 06/4/25 from 12:55pm-1:45pm. On 06/4/25 from 12:55pm-1:45pm LPA conducted a records review. The investigation revealed the following: Allegation: Staff are not taking universal precautions to ensure COVID is not spread. It is being alleged that Covid protocols are not being followed. On 06/04/24 from 10:15am- 11:22am LPA conducted interviews with R2-R7 regarding the allegation above, 6 of 7 residents interviewed denied the allegation above, per 6 of 7 residents interviewed reported being informed of positive covid cases and have been tested daily. On 06/04/25 and 06/13/25 LPA conducted interviews with S1-S5 regarding the allegation above, 5 of 5 staff interviewed denied the allegation above and reported that staff and residents are tested daily, staff received infection control training, and that families and Primary Care Physicians were made aware of covid positive cases via email. On 06/4/25 from 12:55pm-1:45pm LPA conducted a records review, during the records review, LPA observed the Facility’s Residential infection control plan and the Emergency and disaster plan for residential care facilities for the elderly; both plans are current and updated. LPA observed guidelines regarding how to prevent infection by COVID-19. In addition, LPA reviewed the In-services conducted on topics including, Universal precautions for infection control, COVID-19 plan, COVID-19 testing sites and kits, Use of PPE (Personal Protective Equipment) when handling COVID-19-positive residents, and PPE. LPA confirmed and observed unusual incident reports dated 06/03/25 were sent from facility to CCLD reporting the Covid- 19 positive staff and residents, LPA observed emails dated 05/28/25, 05/30/25, and 06/02/25 that were sent out to residents, families and friends notifying them and providing them of covid cases and updates, and documented communication between facility and the Long Beach Health Department dated 05/30/25 and 06/03/25. LPA observed staff and residents wearing mask while at the facility during visits. On 06/25/25 LPA conducted a tour of the facility and observed sanitation stations, and cleaning taking place. On 06/25/25 LPA was unable to interview R1 as R1 was sleeping at the time of visit. 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, Jun 25, 2025 · control 11-AS-20250603104702

Allegation investigated: Resident not assisted with medications as prescribed.

On 6/18/2025 at approximately 10:00 AM, LPA Alfonso Iniguez conducted an unannounced complaint visit. LPA Iniguez met with Fabiola Marciano/Executive Director then later with Monique Avila/Wellness Director. LPA Iniguez explained the purpose of this visit. Investigation Consisted of: LPA conducted the following interviews: Staff Interviews (S#1). LPA obtained and reviewed the following documents: Resident Roster dated: 6/18/25, Staff Roster dated: 6/17/25,Copy of (R#1)’s prescription order for Seroquel (Quetiapine Fumarate 50 MG Tab) dated:1/20/25, Copy of (R#1)’s Physicians Report for Residential Care Facilities for the Elderly (RCFE) or LIC 602A dated: 2/12/25, Copy of (R#1)’s Medication Administration Record (MARs) for June 2025, and copy of (R#1) video recording dated: 6/8/25 at approximately 10:30 pm. Evaluation Report continues LIC 9099-C Substantiated Investigation Revealed the Following: Allegation: Resident not assisted with medications as prescribed. The details of the complaint alleged that facility staff is not giving (R#1) medication as prescribed by their physician. On June 18, 2025, at approximately 2:00 PM, during a records review, LPA Iniguez observed (R#1) 's prescription order for Seroquel (Quetiapine Fumarate 50 MG Tab), dated 1/20/25. The order specifies a time of 8:00 PM to administer this medication at nighttime. Additionally, LPA Iniguez observed (R#1)'s Medication Administration Record (MAR) for June 2025. LPA Iniguez observed that on 6/8/25, facility staff marked down the medication given to (R#1) at 8:00 PM. Also, the (MARs) extra notes for 6/8/25 do not show (R#1) refused the medication. However, LPA Iniguez observed a video recording obtained by the department with a time stamp of 2025/6/8 at approximately 10:32 PM. The video shows (S#2) waking up (R#1) and administering the medication that was supposed to be given at 8:00 PM, as per the doctor's order. In addition, LPA Iniguez reviewed (R#1) 's Physician's Report for Residential Care Facilities for the Elderly (RCFE) or LIC 602A, dated 2/12/25. It was confirmed that (R#1) is unable to administer or store their own medications. On June 18, 2025, at approximately 02:00 PM, during interviews with facility staff (S#1), she stated that on 6/8/25 at approximately 10:32 PM, (S#2) forgot to give (R#1) medication at 8:00 PM. (S#1) instructed (S#2) to administer the medication to (R#1) at that time. Evaluation Report continues LIC 9099-C During this investigation, LPA found sufficient evidence to support the above-mentioned allegation. 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 was conducted, and a copy of the Complaint Report was given to Monique Avila/Wellness Director.the state’s words, verbatim · CDSS document, Jun 18, 2025 · control 11-AS-20250609165123

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87465(a)(4) · Plan of correction due date: Jun 30, 2025

87465 Incidental Medical and Dental Care (a) A plan for incidental medical and dental care shall be developed by each facility. The plan shall encourage routine medical and dental care and provide for assistance in obtaining such care, by compliance with the following: (4) The licensee shall assist residents with self-administered medications as needed. This requirement was not met as evidence by: Based on observation and record review, facility staff failed to ensure medication for (R#1) was not administered as per the doctor's order. This poses a potential health and safety risk to residents in care.the state’s words, verbatim · CDSS document, Jun 18, 2025

Plan of correction: Licensee will adhere to Title 22 at all times. As plan of correction a disciplinary action for (S#2) and re-training on medication managment. Proof of correction will be sent to LPA Iniguez via email before POC due date.

Allegation investigated: Illegal Eviction

***This report supersedes the report dated 05/23/25. This report is being created to remove the unsubstantiated allegation of “Illegal Eviction” to substantiated. All other aspects of the complaint report remain in effect.*** On June 18, 2025, the California Department of Social Services Community Care Licensing (CDSS/CCL) Licensing Program Analyst (LPA) Ernand Dabuet made this unannounced subsequent complaint visit for the purpose of delivering findings for the investigation into the above identified complaint allegation. The LPA met with facility Executive Director Fabiola Marciano and explained the reason for today’s inspection. The investigation consisted of interviews, a collection of records, and a tour of the facility. Interviews were conducted with staff members #1 to #3 (S1-S3) resident member #1 (R1) and witness #1 (W1). (Evalution Report continues LIC 9099-C) Substantiated List of documents reviewed/obtained Faciltiy Resident Roster (dated 05/23/25), Personne Report LIC 500 (dated 05/12/25), (R1)'s Physician's Report LIC 602A (dated 08/19/24 and 02/12/25), Facility Resident Assessment (dated 04/23/25), Resident Lease Agreement (dated 8/24/24), Personal Rights LIC 603C (dated 08/24/24), 30-Day Notice of Termination of Residency Letter (dated 04/14/25), and Family Council Meetings and Follow-up Email Correspondences (dated 12/25/24, 02/12/25, 02/22/25, 04/08/25, 04/15/25 and 05/06/25) and other pertinent records associated with this investigation. Investigation Revealed the Following: Allegation #2: Illegal Eviction. The complaint alleges that the facility issued an illegal eviction to Resident #1 (R1). It reported that the facility failed to issue a legal eviction because the notice was defective. The notice failed to state any of the five legal reasons for the eviction and failed to provide details required by Title 22 Regulations. On May 23, 2025, between 09:30 AM and 10:50 AM, the Department interviewed staff members identified as Staff #1 through Staff #3 (S1-S3). Three (3) out of the three (3) staff members confirmed that a 30-Day Notice of Termination of Residency Letter (dated 04/14/25) was issued to Resident #1 (R1) along with the family representative and Community Care Licensing (CCL). According to (S1-S3) this Eviction Notice has now been dismissed as of May 19, 2025. On May 23, 2025, between 11:00 AM and 11:10 AM, the Department interviewed a resident member identified as Resident #1 (R1). (R1) asserted was completely unaware of any eviction notice that had been issued by the facility staff. On May 23, 2025, between 9:50 AM and 10:12 AM, the Department interviewed a witness member identified as Witness #1 (W1) the power of attorney for (R1). (W1) acknowledged a 30-Day Notice of Termination (dated 04/15/25) was received. (W1) addressed that the Notice of Termination dated April 14, 2025, has been dismissed. A review of (R1)’s 30-day Notice of Termination Letter (dated 04/15/25) and Fed Ex Receipt (dated 04/15/25) was sent to (R1), family representative, and an email receipt to Community Care Licensing (CCL). The 30-Day Notice of Termination under Title 22 Regulation 87244 Eviction Procedures subsection (d) The licensee shall set forth in the Notice to quit the reasons relied upon for the eviction with specific facts to permit determination of the date, place, witnesses, and circumstances concerning those reasons. (Evaluation Report continues LIC 9099-C) List of documents reviewed/obtained Faciltiy Resident Roster (dated 05/23/25), Personne Report LIC 500 (dated 05/12/25), (R1)'s Physician's Report LIC 602A (dated 08/19/24 and 02/12/25), Facility Resident Assessment (dated 04/23/25), Resident Lease Agreement (dated 8/24/24), Personal Rights LIC 603C (dated 08/24/24), 30-Day Notice of Termination of Residency Letter (dated 04/14/25), and Family Council Meetings and Follow-up Email Correspondences (dated 12/25/24, 02/12/25, 02/22/25, 04/08/25, 04/15/25 and 05/06/25) and other pertinent records associated with this investigation. Investigation Revealed the Following: Allegation #1: Staff retaliated against resident resulting in eviction. The complaint alleges that the facility staff retaliated against a resident, leading to an eviction. Reports indicate that Regency Palms attempted to evict Resident #1 (R1) in a classic retaliation case. It appears that the facility is using unspecified incidents, which are common among residents with Major Neurocognitive Disorder (NCD), as justification for removing (R1). The family representative for (R1) is part of the Family Council. The facility does not want to evict (R1); instead, it tries to stop the family's advocacy efforts. On May 23, 2025, between 09:30 AM and 10:50 AM, 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 allegation. (S1-S3) denied any retaliation. (S1-S3) are aware that the incidents involving (R1) are not used for retaliation to serve for an eviction. (S1-S3) stated that they denied having retaliation due to (R1)’s family representatives’ involvement with the Family Council for Regency Palms. (S1-S3) stated the family’s involvement with the Family Council held monthly. These council meetings are specifically for residents and family members, and no Regency Palms personnel or staff are ever involved in these meetings. (S1) is notified when the meeting is scheduled and will promote it by posting in public spaces where visitors congregate. (S2-S3) stated they are not privileged to discuss any topics at these meetings, minutes a written record of a meeting, or capture key discussions, decisions, and action items. On May 23, 2025, between 11:00 AM and 11:10 AM, the Department interviewed a resident member identified as Resident #1 (R1). (R1) uttered an appreciation for living at the facility, highlighting the staff's friendly demeanor, who have consistently treated (R1) with kindness and respect. (R1) confidently stated that there had been no experience of mistreatment during (R1)'s stay. Furthermore, (R1) expressed surprise when asked about any eviction notice, indicating a complete lack of awareness regarding such a matter. (Evaluation Report continues LIC 9099-C) On May 23, 2025, between 9:50 AM and 10:12 AM, the Department interviewed a witness member identified as Witness #1 the power of attorney for (R1). (W1) reiterated incidents that occurred with (R1) at the facility and felt that these incidents were reasons for the eviction, and perhaps the family representative’s advocate for (R1) is a retaliation for the eviction served to (R1) in April 2025. (W1) stated that they did not have demonstrative evidence or written communications, including emails and text messages, related to providing as retaliation for the family’s involvement with the Family Council. After reviewing the Physician's Report LIC 602A for (R1) (dated 08/19/24 and 02/12/25), Facility Resident Assessment (dated 04/23/25) revealed with (R1) is diagnosed with (NCD). A review of the Resident Lease Agreement (dated 8/24/24) included Eviction, Family Council, House Rules, Complaint & Concerns, Complaint Grievance Policy procedures. Personal Rights LIC 603C (dated 08/24/24) acknowledged by (R1) with signature. 30 Day Notice of Termination of Residency Letter (dated 04/14/25), and Family Council Meetings and Follow-up Email Correspondences (dated 12/25/24, 02/12/25, 02/22/25, 04/08/25, 04/15/25 and 05/06/25) revealed no written action of retaliation. During the May 23, 2025, visit, the Department identified that the facility promotes the rights of its residents. To improve the environment, the facility posted the Resident Rights, Personal Rights, California Residential Care Facilities for the Elderly Complaint Poster, California Long Term Ombudsman Poster, and the Family Council Meeting Poster. 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 allegations. Although the allegation may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violations occurred. Therefore, the allegations isUnsubstantiated. An exit interview conducted with Executive Director Fabiola Marciano and copies of the report provided. This information was excluded from the Notice and does not meet Title 22 requirements. Based on the information gathered, there is sufficient evidence to support the allegation mentioned above. Based on observations, interviews, record reviews, and analysis, the preponderance of evidence standard has been met; therefore, the allegation that "Illegal Eviction" is determined Substantiated. California Code of Regulations, Title 22, Division 6, and Chapter 8 are being cited on the attached LIC 9099-D. An exit interview conducted with Executive Director Fabiola Marciano and copies of the report provided.the state’s words, verbatim · CDSS document, Jun 18, 2025 · control 11-AS-20250513084722

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87244(d) · Plan of correction due date: Jun 25, 2025

87224 Eviction Procedures (d) The licensee shall set forth in the notice to quit the reasons relied upon for the eviction with specific facts to permit determination of the date, place, witnesses, and circumstances concerning those reasons. This requirement is not met as evidenced by: Based on the record review, the licensee failed to provide a valid Notice to Quit per Title 22 Reg 87244(d). This poses a potential Health, Safety, or Personal Rights risk to persons in care.the state’s words, verbatim · CDSS document, Jun 18, 2025

Plan of correction: The licensee will comply with Title 22 Reg 87244 and resubmit a Notice to Quit, per Title 22 87244. Proof of correction of a revised Notice to Quit must be sent to LPA Dabuet by 06/28/25 at ernand.dabuet@dss.ca.gov This citation was corrected during visit on 05/23/25. The Notice of Termination was dismissed on 05/19/25 and a new Notice of Termination was submitted on 05/22/25.

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

On 06/13/2025, at 10:00am, Licensing Program Analyst (LPA) Zina Brown conducted a subsequent complaint visit at this facility to deliver the complaint findings. During today’s visit, LPA met with Fabiola Maricano (Executive Director) and explained the purpose of the visit. The investigation consisted of the following: An initial complaint visit was completed by the department on 05/12/2025 during the visit conducted interviews with Administrator (A1), Staff (S1-S7) and Residents (R1-R8) between the hours of 10:30 am – 1:42pm. The department received the following documents: Resident Roster (received 06/13/2025), Staff Roster (dated 06/01/2025), LIC 601 Identification and Emergency Information (for R1) - dated 07/11/2024, LIC 602: Physician Report for RCFE (for R1) - dated 04/17/2025, LIC 603A: Preplacement Appraisal (for R1) - dated 07/11/2024, LIC 624: Unusual Incident/Injury Report - dated 06/03/2025, Admission Agreement – (dated 07/11/2024) & Medication Administration Record April 2025 - May 2025. Unsubstantiated The investigation revealed the following: Allegation – Staff did not prevent a resident from sustaining an unexplained injury. It is alleged that R1 has left under eye bruising. On 06/13/2025 at 2:50 PM, LPA conducted a records review of R1’s file. In the review of R1's records, LPA discovered the LIC 624 was faxed to the Department on 06/03/2025 at 2:57pm which states R1 woke up with bruising under his left eye. Resident didn't not complain of pain, discomfort nor distress. R1 stated he slept with glasses the night before and noticed it and took them off. On 06/13/2025, the department interviewed the Administrator (A1)between the hours of 1:30pm - 1:42pm. A1 stated being aware of unknown bruising under left eye of R1. A1 stated the facility submitted an incident report to the department. Between the hours of 11:53am -1:17pm, LPA interviewed Staff 1 (S1) - Staff 7 (S7) regarding the allegation. 1 of 7 staff confirmed the allegation. 6 of 7 staff were unaware the allegation. The remaining 1 of 7 staff did not confirm or deny the allegation due to not observing or being present during the time. Between the hours of 10:44am - 11:38am, LPA interviewed 8 residents (R1–R8) about the allegation. 1 of 8 residents is aware the allegation and the resident acknowledge the bruise but is unaware of how they received the bruising under left eye. 6 of 8 residents denied the allegation. 1 of 8 residents didn’t confirm nor deny the allegation. Based on records review, interviews, and observation, LPA 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. An exit interview was conducted with Fabiola Marciano, Executive Director and a copy of this report was provided.the state’s words, verbatim · CDSS document, Jun 13, 2025 · control 11-AS-20250605110247

Type of visit: Office

This report supersedes report dated 05/08/2025. On 06/06/2025 at 12:00 pm, an office visit was held by the El Segundo Adult and Senior Care Regional Office. During the meeting the following people were present: Benita Yates (Regional Manager), Janae Hammond (Licensing Program Manager), Zina Brown (Licensing Program Analyst), Fabiola Marciano (Executive Director), Lisa To (Regional Director) and facility representative: Christine Hannah (Managing Member for the Licensee) and Sarang Tatimatla (CRO Board Member) to issue deficiencies identified during unrelated complaint investigation 11-AS-20250417101102. On 01/06/2025 and 04/18/2025, the Department received information indicating that video surveillance with an audio component was being used in four resident bedrooms (three shared and one private). On 04/23/2025 & 05/08/2025 the Department conducted a comprehensive review of facility operations and practices. A physical tour of the facility was conducted and the following records were obtained and reviewed: Register of Residents, Physician Reports for Residents #1 thru #7 (R1 to R7); Power of Attorney for Resident #3 & Resident # 7; Advance Health Directive for R1, and Admission Agreements for R1 to R7. Report continues on LIC 809C page. On April 22, 2025, the department reviewed the facility's plan of operation including admission agreement which the review revealed that Regency Palms Long Beach stated in the plan of operations that video surveillance wouldn't be used in residents rooms too protect privacy. Further review of the admission agreement—specifically page 6 section “miscellaneous,” item 10.9—state “due to privacy of residents, residents will not have nanny cam’s in there apartment.” Contrary to these stated policies, the Department observed, during a facility tour, signage on rooms 302, 303, 305, and 502 indicating that video surveillance was active in those rooms. Interviews were conducted with the Administrator (A1) on April 23, 2025. A1 confirmed that video surveillance devices, including audio components, were installed in four resident rooms. A1 stated that the video surveillance was installed by residents' families and that facility staff did not have access to the video recordings. A1 provided the following room-specific details: Room 302 (shared): Both R2 and R3 have video surveillance with an audio component. Room 303 (shared): R1 has video surveillance with an audio component; R4 does not. Room 305 (private): R7 has video surveillance with an audio component. Room 502 (shared): R5 has video surveillance with an audio component; R6 does not. On May 27, 2025, the Department interviewed W1, the responsible party for 1 out of 7 residents who did not have capacity. W1 stated they were not informed of any video or audio surveillance in the residents’ room and did not provide consent for its installation or use. W1 further expressed concerns about the surveillance constituting an invasion of privacy, particularly given the potential recording of confidential medical information. Report continues on LIC 809-C page. On 05/28/2025, the Department interviewed one of the seven residents. The resident denied any knowledge of the presence of video or audio surveillance in their shared room and denied giving consent for such surveillance. Based on observations, review of facility records, and interviews, the Department finds that Regency Palms Long Beach is in violation of its approved Plan of Operation and Admission Agreement by allowing video surveillance with audio capabilities in residents' bedrooms. Furthermore, the facility failed to safeguard residents’ personal rights, as required by Title 22 regulations. Specifically, 2 out of 7 residents’ right to privacy was violated due to the presence of video surveillance with an audio component capturing private conversations, including those with family members, visitors, and the Ombudsman. Deficiencies are cited under California Code of Regulations, Title 22, Division 6, Chapter 8, and are documented on the attached LIC 809-D. An exit interview was conducted with Executive Director Fabiola Marciano. A copy of this report, along with appeal rights, was provided.the state’s words, verbatim · CDSS document, Jun 6, 2025

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87208(a) · Plan of correction due date: Jul 6, 2025

Plan of Operations: The licensee shall have and maintain a current, written definitive plan of operation for the facility. The licensee shall operate the facility in accordance with the terms specified in the plan of operation. . . This requirement is not met as evidenced by: Based on interviews conducted and records review the facility is not following the approved plan of operation by allowing the use of video surveillance in four (4) resident rooms.the state’s words, verbatim · CDSS document, Jun 6, 2025

Plan of correction: The facility will be reviewing the Plan of Operation and updating to adhere with current Title 22 regulations but will not seek changes with the use of video surveillance with audio and will submit plan of operation to department by POC due date via email at Zina.Brown@dss.ca.gov

From the deficiency page — Deficiency type: Type B · Section cited: CCR87468.2(a)(1) · Plan of correction due date: Jun 30, 2025

Additional Personal Rights of Residents in All Facilities, residents in privately operated residential care facilities. . . to have a reasonable level of personal privacy in accommodations. This requirement is nor met as evidenced by: Based on interview conducted and record review. . . Based on interviews and records reviewed the facility violated 2 out of 7 residents right to privacy by allowing the use of video surveillance with audio in residents rooms without consent.the state’s words, verbatim · CDSS document, Jun 6, 2025

Plan of correction: The facility will notify the families of the residents in the shared room who do not have video survilleance with audio installed in the shared room with resident who still have video survilleance with audio in use of the shared room and will submit proof of notification to the department by POC due date via email at Zina.Brown@dss.ca.gov

Allegation investigated: Resident not assisted with medications as prescribed.

On 5/29/2025 at approximately 9:30 AM, LPA Alfonso Iniguez conducted an unannounced complaint visit. LPA Iniguez met with Fabiola Marciano/Executive Director and later with Monique Avila/Wellness Director. LPA Iniguez explained the purpose of this visit. Investigation Consisted of: LPA conducted the following interviews: Executive Director(A#1), Staff Interviews (S#1-S#3). LPA obtained and reviewed the following documents: Resident Roster dated: 5/29/25, Staff Roster dated: 5/12/25, (R#1-R#4) Physicians Report for Residential Care Facilities for the Elderly (RCFE) or LIC 602A dated: 8/18/24, 4/5/25, 3/7/24 and 4/22/25, and (R#1)’s Copies of Medication Administration (MARs) for March, April and May of 2025. Evaluation Report continues LIC 9099-C Substantiated Investigation Revealed the Following: Allegation: Resident not assisted with medications as prescribed. The details of the complaint alleged that facility did not follow (R#1)’s prescribed medications order. On May 29, 2025, at approximately 3:00 PM, during a records review, LPA Iniguez observed Resident #1's Medication Administration Records (MARs) for April 2025. LPA Iniguez noted that the medication order for Ferrous Sulfate 325 MG Tablet prescribed one tablet to be taken by mouth once daily on Mondays, Wednesdays, and Fridays until April 23, 2025, when the physician discontinued it. However, facility staff documented on the MARs that they administered the medication to (R#1) for nine consecutive days, from April 14, 2025 (Monday) to April 22, 2025 (Tuesday). LPA Iniguez found that facility staff did not follow the prescribed medication order for (R #1). Moreover, LPA Iniguez reviewed (R#1)’s Physicians Report for Residential Care Facilities for the Elderly (RCFE) or LIC 602A dated: 8/19/24, it is noted that (R#1) is not able to administer their own prescribed medications. On May 29, 2025, at approximately 10:00 AM, during an interview with the Administrator (A#1), she stated that there is an ongoing investigation to determine why the facility did not follow up on the order. On May 29, 2025, at approximately 2:00 PM, interviews with facility staff (S#1-S#3) revealed that all (3) staff members did not follow up on (R#1)’s medication order prescribed by their physician. Evaluation Report continues LIC 9099-C During this investigation, LPA found sufficient evidence to support the above-mentioned allegation. 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 was conducted, and a copy of the Complaint Report was given to Monique Avila/Wellness Director. Investigation Revealed the Following: Allegation: Facility allowed resident t to be restrained. The details of the complaint alleged that facility did not follow (R#1)’s doctors’ orders on restrains. On May 29, 2025, at approximately 3:00 PM, during a records review, LPA Iniguez examined the facility file for (R#1). Within this file, LPA Iniguez found copies of Nurse Practitioner (NP) orders related to restraints. The first order dated January 9, 2025, states that it is permissible for (R#1)’s family to apply a nighttime restraint, provided by (R#1)’s family. The family assumes responsibility for any adverse occurrences and risks discussed with the care facility. Additionally, LPA Iniguez found another NP restraint order dated February 7, 2025, which instructs to discontinue all restraints that had been placed on (R#1) by the family. On May 29, 2025, at approximately 10:00 a.m., during an interview with the Administrator (A#1), she stated that the facility always follows the orders of the residents’ doctors or Nurse Practitioners. In addition, (A#1) stated that yes, we follow the Nurse Practitioner (NP) order for restraints regarding (R#1). The family is supposed to put the restraints on at night, and we will remove them in the morning. The order was discontinued by the (NP) after a month. On May 29, 2025, at approximately 3:00 PM, during interviews with residents (R#1-R#7), (7) out of (7) stated that they received their medical orders from their physician here at the facility. Additionally, (7) out of (7) residents in care stated that they believe the facility staff follow the orders as prescribed by their physician. On May 29, 2025, at approximately 1:00 PM, during interviews with facility staff (S#1-S#3), (3) out of (3) stated that (R#1) had a prescribed order for restrains. They followed the order as noted by the Nurse Practitioner (NP) until it was discontinued on 2/7/25. Evaluation Report continues LIC 9099-C During this investigation, LPA found did not find sufficient evident to support the above-mentioned allegation(s). Based on the evidence gathered, interviews conducted, and records reviewed, the preponderance of evidence standard has been met; therefore, the above-mentioned allegation(s) are found to be UNSUBSTANTIATED. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur. An exit interview was conducted, and a copy of the Complaint Report was given to Monique Avila/Wellness Director.the state’s words, verbatim · CDSS document, May 29, 2025 · control 11-AS-20250522130604

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87465(a)(4) · Plan of correction due date: Jun 16, 2025

87465 Incidental Medical and Dental Care (a) A plan for incidental medical and dental care shall be developed by each facility. The plan shall encourage routine medical and dental care and provide for assistance in obtaining such care, by compliance with the following: (4) The licensee shall assist residents with self-administered medications as needed. This requirement was not met as evidence by: Based on observation and record review, facility staff failed to ensure medication for (R#1) was not administered accurately. This poses a potential health and safety risk to residents in care.the state’s words, verbatim · CDSS document, May 29, 2025

Plan of correction: Licensee will adhere to Title 22 at all times. As plan of correction the facility will re-train staff on how to document correctly on the MARs. Proof of training will be sent to LPA Iniguez via email before the POC due date.

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

On 5/23/25, at 09:00am, the department conducted an initial complaint visit to the facility and was greeted by Fabiola Marciano, Executive Director. The department explained the purpose of this visit is to gather information about the complaint, gather facility files, interview staff/residents, and deliver findings for the allegation mentioned above. The investigation consisted of the following: The department investigated the allegation mentioned in this complaint; and conducted interviews with staff (S1-S7) and residents (R1-R6) from 10:00am-2:00pm. The department received the following documents: Resident Roster (Dated: No Date), Staff Roster (Dated: 05/12/2025), Work Order for Emergency Pull Chord (Dated:05/23/2025), Resident Incident Details Report (Dated: 05/18/2025-05/24/2025), Admission Agreements (Dated:02/19/2024, 10/16/2024, 04/15/2023), ID Emergency Information (Dated: 9/25/2022, 02/18/2024), Physicians Report (Dated: 03/11/2025, 10/17/2023), and Resident Appraisal (Dated:09/1/2024, 10/14/2024, 02/01/2025) from the facility. Report Continued on LIC9099-C Substantiated The investigation revealed the following: Allegation-Staff did not provide adequate supervision to resident(s) in care. The details of the complaint alleged that an alarm was going off in a resident’s room from 9:00am -9:25am on 05/19/25, but no one came to see what the problem was or if the resident was in danger or needed care. On 5/23/25, from 10:00am-2:00pm, the department interviewed staff (S1-S7) and residents (R1-R6) regarding the allegation. 6 of 7 staff denied the allegation that the Staff did not provide adequate supervision to resident(s) in care. All staff stated that all residents are provided with adequate supervision and if assistance is needed, residents have the option of using the call buttons in their room, pendants, or the motion sensors would alert staff that the resident needs assistance. One staff was aware that room 302B was having problems with the emergency pull chord device. The department interviewed residents (R1-R6) about the allegation and 5 of 6 residents that were interviewed denied the allegation that Staff did not provide adequate supervision to resident(s) in care. The majority of residents interviewed stated that the staff are meeting their needs and are satisfied with the care and supervision they are receiving at the facility. The Department toured room 302B and pulled the emergency pull chord, the light was flashing, but no one came to assist. The department observed the reason no one came to assist was because the signal system was not transmitting an auditory signal to the care staff. The department reviewed the Resident Incident Details Report (Dated: 05/18/2025-05/24/2025) and observed that on 05/19/2025 between 7:02am-09:23am the device was in motion but was not communicating with staff. The staff provided the department with a work order (Dated: 05/23/2025) for room 302B to address the pull chord and verify that the connection is working. Based on observation, interviews conducted, and records reviewed, the preponderance of evidence standard has been met. Therefore, the above allegation Staff did not provide adequate supervision to resident(s) in care, is found to be Substantiated. The emergency pull chord in the resident’s room was not working and poses a potential health and safety risk. California Code of Regulations, Title 22, Division (6) and chapter (8) are being cited on the attached LIC 9099D. Note: *Citations that are not cleared by the due date of 06/13/2025 will have a $100 fine assessed for each citation until it is cleared. Civil penalties will continue to accrue until Proof of Corrections (POC) is cleared. Deficiencies are issued and plans of corrections were discussed. An exit interview was conducted with Fabiola Marciano, Executive Director, and a hard copy of this Complaint Investigation Report was provided.the state’s words, verbatim · CDSS document, May 23, 2025 · control 11-AS-20250520112257

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87303(i)(B) · Plan of correction due date: May 29, 2025

87303(i)(B) Maintenance and Operation. (i) Facilities shall have signal systems which shall meet the following criteria: (B) Transmit a visual and/or auditory signal to a central staffed location or produce an auditory signal at the living unit loud enough to summon staff. This requirement is not met as evidenced by: Based on observation and records reviewed, LPA observed that the emergency signal system in room 302B does not currently transmit an auditory signal to a central staffed location, which poses a potential health and safety risk to residents in care.the state’s words, verbatim · CDSS document, May 23, 2025

Plan of correction: The Administrator will adhere to Title 22 regulations 87303(i)(B) Maintenance and Operation and submit a work order for the emergency pull chord device in room 302B to be repaired by the plan of correction due date of 06/13//25. Facility will submit proof that the device was repaired to LPA’s email address at perry.scott@dss.ca.gov to avoid monetary penalties.

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

On May 23, 2025, the California Department of Social Services Community Care Licensing (CDSS/CCL) Licensing Program Analyst (LPA) Ernand Dabuet conducted an initial visit to gather information regarding the above allegations. LPA met with Fabiola Marciano, Executive Director, and explained the purpose of the visit. LPA was granted entry to the facility. The investigation consisted of interviews, a collection of records, and a tour of the facility. Interviews were conducted with staff members #1 to #3 (S1-S3) resident member #1 (R1) and witness #1 (W1). List of documents reviewed/obtained Faciltiy Resident Roster (dated 05/23/25), Personne Report LIC 500 (dated 05/12/25), (R1)'s Physician's Report LIC 602A (dated 08/19/24 and 02/12/25), Facility Resident Assessment (dated 04/23/25), Resident Lease Agreement (dated 8/24/24), Personal Rights LIC 603C (dated 08/24/24), 30-Day Notice of Termination of Residency Letter (dated 04/14/25), and Family Council Meetings and Follow-up Email Correspondences (dated 12/25/24, 02/12/25, 02/22/25, 04/08/25, 04/15/25 and 05/06/25) and other pertinent records associated with this investigation. (Evaluation Report continues LIC 9099-C) Unsubstantiated INVESTIGATION REVEALED THE FOLLOWING: Allegation #1: Staff retaliated against resident resulting in eviction. The complaint alleges that the facility staff retaliated against a resident, leading to an eviction. Reports indicate that Regency Palms attempted to evict Resident #1 (R1) in a classic retaliation case. It appears that the facility is using unspecified incidents, which are common among residents with Major Neurocognitive Disorder (NCD), as justification for removing (R1). The family representative for (R1) is part of the Family Council. The facility does not want to evict (R1); instead, it tries to stop the family's advocacy efforts. On May 23, 2025, between 09:30 AM and 10:50 AM, 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 allegation. (S1-S3) denied any retaliation. (S1-S3) are aware that the incidents involving (R1) are not used for retaliation to serve for an eviction. (S1-S3) stated that they denied having retaliation due to (R1)’s family representatives’ involvement with the Family Council for Regency Palms. (S1-S3) stated the family’s involvement with the Family Council held monthly. These council meetings are specifically for residents and family members, and no Regency Palms personnel or staff are ever involved in these meetings. (S1) is notified when the meeting is scheduled and will promote it by posting in public spaces where visitors congregate. (S2-S3) stated they are not privileged to discuss any topics at these meetings, minutes a written record of a meeting, or capture key discussions, decisions, and action items. On May 23, 2025, between 11:00 AM and 11:10 AM, the Department interviewed a resident member identified as Resident #1 (R1). (R1) uttered an appreciation for living at the facility, highlighting the staff's friendly demeanor, who have consistently treated (R1) with kindness and respect. (R1) confidently stated that there had been no experience of mistreatment during (R1)'s stay. Furthermore, (R1) expressed surprise when asked about any eviction notice, indicating a complete lack of awareness regarding such a matter. On May 23, 2025, between 9:50 AM and 10:12 AM, the Department interviewed a witness member identified as Witness #1 the power of attorney for (R1). (W1) reiterated incidents that occurred with (R1) at the facility and felt that these incidents were reasons for the eviction, and perhaps the family representative’s advocate for (R1) is a retaliation for the eviction served to (R1) in April 2025. (W1) stated that they did not have demonstrative evidence or written communications, including emails and text messages, related to providing as retaliation for the family’s involvement with the Family Council. (Evaluation Report continues LIC 9099-C) After reviewing the Physician's Report LIC 602A for (R1) (dated 08/19/24 and 02/12/25), Facility Resident Assessment (dated 04/23/25) revealed with (R1) is diagnosed with (NCD). A review of the Resident Lease Agreement (dated 8/24/24) included Eviction, Family Council, House Rules, Complaint & Concerns, Complaint Grievance Policy procedures. Personal Rights LIC 603C (dated 08/24/24) acknowledged by (R1) with signature. 30 Day Notice of Termination of Residency Letter (dated 04/14/25), and Family Council Meetings and Follow-up Email Correspondences (dated 12/25/24, 02/12/25, 02/22/25, 04/08/25, 04/15/25 and 05/06/25) revealed no written action of retaliation. During the May 23, 2025, visit, the Department identified that the facility promotes the rights of its residents. To improve the environment, the facility posted the Resident Rights, Personal Rights, California Residential Care Facilities for the Elderly Complaint Poster, California Long Term Ombudsman Poster, and the Family Council Meeting Poster. Based on the information gathered, there is not enough evidence to support the allegation mentioned above. Allegation #2: Illegal Eviction. The complaint alleges that the facility issued an illegal eviction to Resident #1 (R1). It reported that the facility failed to issue a legal eviction because the notice was defective. The notice failed to state any of the five legal reasons for the eviction and failed to provide details required by Title 22 Regulations. On May 23, 2025, between 09:30 AM and 10:50 AM, the Department interviewed staff members identified as Staff #1 through Staff #3 (S1-S3). Three (3) out of the three (3) staff members confirmed that a 30-Day Notice of Termination of Residency Letter (dated 04/14/25) was issued to Resident #1 (R1) along with the family representative and Community Care Licensing (CCL). According to (S1-S3) this Eviction Notice has now been terminated as of May 19, 2025, and is no longer valid. On May 23, 2025, between 11:00 AM and 11:10 AM, the Department interviewed a resident member identified as Resident #1 (R1). (R1) asserted was completely unaware of any eviction notice that had been issued by the facility staff. On May 23, 2025, between 9:50 AM and 10:12 AM, the Department interviewed a witness member identified as Witness #1 (W1) the power of attorney for (R1). (W1) acknowledged a 30-Day Notice of Termination (dated 04/15/25) was received. (W1) addressed that the Notice of Termination dated April 14, 2025, has become invalid. (Evaluation Report continues LIC 9099-C) A review of (R1)’s 30-Day Notice of Termination Letter (dated 04/15/25) and Fed Ex Receipt (dated 04/15/25) was sent to (R1), family representative and an email receipt to Community Care Licensing (CCL). 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 allegations. Although 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. An exit interview conducted with Executive Director Fabiola Marciano and copies of the report provided.the state’s words, verbatim · CDSS document, May 23, 2025 · control 11-AS-20250513084722

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

This report supersedes the previous reports LIC9099 and LIC9099-C, created on April 23, 2025. The findings regarding the complaint remain unchanged. On 05/21,2025, LPA Richard conducted a subsequent visit and met with Executive Director Marciano and explained the visit. The investigation consisted of the following. On 05/21/1025, LPA obtained facility progress notes (dated March 1,10 and April 10, and 13, 2025). On 04/23/25, Licensing Program Analyst (LPA) Antonine Richard conducted an unannounced complaint investigation regarding the allegation listed above. LPA met with Executive Director Fabiola Marciano, and the purpose of the visit was explained. A tour of the facility was conducted. On 04/23/2025, LPA Richard received facility records which consisted of Staff Roster, Client Roster, House Rules, Resident #1 (R1) records, including Physician’s Report, Admission Agreement, Identification and Emergency Information (LIC 601), Resident Appraisal (LIC603), Unusual Incident Reports, and a copy of the Eviction Notice (dated 04/14/25). Reassessment (dated 04/01/25). Concise Care Group Placement emails (dated 02/14/25 to 04/18/25). Interviews were conducted with three (3) staff (S1-S3), including the Executive Director, and two residents (R1-R2). Unsubstantiated Regarding the allegation: Licensee initiated the eviction process in retaliation against the resident. It is alleged that the client received an eviction letter on April 15, 2025, instructing them to vacate the facility by May 14, 2025. On April 23, 2025, LPA interviewed two residents (R1- R2); both were unable to answer the questions posed fully. Additionally, on the same date, the LPA interviewed three staff members (S1, S2, and S3), all of whom denied the allegation that the Licensee initiated the eviction process in retaliation against the residents. The staff members stated that the eviction was issued following a reassessment that determined the resident required a higher level of care and supervision. On April 23, 2025, between 11:00 AM and 12:00 PM, LPA conducted a records review of the reassessment for resident #1 (R1), dated April 1, 2025, indicated that R1's condition had changed, necessitating a higher level of care and supervision. On 05/21/2025, the department reviewed the facility's progress notes dated March 1, 10, 2025, and April 10 and 13, 2025, indicating that R1 had been very aggressive towards other residents and staff by punching and scratching them. On 04/15/2025, LPA confirmed that a 30-day eviction notice and supporting documents were faxed to Community Care Licensing within five days, by the California Code of Regulations, Title 22. It was determined that the facility could not meet R1's needs due to the requirement for a higher level of care. Based on interviews and records reviewed, there was not 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 unsubstantiated. There were no deficiencies cited. An exit interview was conducted a copy of the report was provided to Wellness Director Monique Avila.the state’s words, verbatim · CDSS document, May 21, 2025 · control 11-AS-20250417101102

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

On 5/21/2025 at approximately 9:40 AM, LPA Alfonso Iniguez conducted an unannounced complaint visit. LPA Iniguez met with Fabiola Marciano/Executive Director and later with Monique Avila/Wellnes Director. LPA Iniguez explained the purpose of this visit. Investigation Consisted of: LPA conducted the following interviews: Executive Director(A#1), Staff Interviews (S#1-S#5), Resident’s interviews (R#1-R#7). LPA obtained and reviewed the following documents: Resident Roster dated: 5/21/25, Staff Roster dated: 5/12/25, (R#1-R#4) Physicians Report for Residential Care Facilities for the Elderly (RCFE) or LIC 602A dated: 8/18/24, 4/5/25, 3/7/24 and 4/22/25 (R#1-R#4) Admissions Agreement dated: 8/24/24, (R#1-R#4) Identification and Emergency Information or LIC 601 dated: 8/24/24, 1/20/24, 4/27, 4/25/25, (R#1-R#4) Service Plan dated: 4/25/25, 4/22/25, 3/31/25 and 5/21/25 and Copies of Resident Incident Details Report for room # 303, 304, 305 and 308 dated: 4/1/25 to 5/22/25 and a Physical Inspection of (R#1)’s room. Evaluation Report continues LIC 9099-C Substantiated Investigation Revealed the Following: Allegation: Staff did not respond to residents’ requests for assistance in a timely manner. The details of the complaint alleged that facility took a long time to tend to (R#2)’s call. On May 21, 2025, at approximately 4:00 PM, during a records review, LPA Iniguez observed the Resident Incident Details Report for the period from April 1, 2025, to May 22, 2025. It was noted that in room 303, where (R#1 and R#2) reside, the maximum time recorded for facility staff response was 3 hours and 53 minutes on May 15, 2025, at approximately 6:58 AM. Additionally, on May 7, 2025, the time recorded was 1 hour and 43 minutes at approximately 8:28 AM. Furthermore, LPA Iniguez found that in room 304, the response time for facility staff was 2 hours and 50 minutes on April 10, 2025, at approximately 7:24 AM, and 1 hour and 6 minutes on May 6, 2025, at approximately 6:31 AM to clear the alarm. On May 21, 2025, at approximately 10:00 AM, during an interview with the Administrator (A#1), she stated that the facility has a pull system, and the facility staff can hear who and where that alarm is coming from. Also, (A#1) stated that it takes approximately 10 minutes to tend to when a resident pulls the alarm. However, (A#1) stated that there have been times when facility staff take longer than 10 minutes to tend to the resident's alarm. On May 21, 2025, at approximately 1:00 PM, during interviews with residents (R#1-R#7), (6) out of (7) stated that they had used the pull alarm system and noticed that the facility staff took longer than 10 minutes to come and assist them. Evaluation Report continues LIC 9099-C On May 21, 2025, at approximately 02:00 PM, during interviews with facility staff (S#1-S#5), (5) out of (5) stated that stated that when it comes to a resident pulling the alarm cord, it takes them approximately 10 minutes. However, (5) out of (5) facility staff stated that there have been times when they have taken more than 10 minutes to help the residents. During this investigation, LPA found sufficient evidence to support the above-mentioned allegation. 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 was conducted, and a copy of the Complaint Report was given to Monique Avila/Wellness Director. Investigation Revealed the Following: Allegation: Staff did not ensure resident’s monitoring device was properly placed. The details of the complaint alleged that (R#1)’s monitoring device is not placed by their bed side. On May 21, 2025, at approximately 3:00 PM, during a records review, LPA Iniguez observed (R#1) ’s Service Plan dated 4/25/25. The plan states that (R#1) is a fall risk, and the facility staff needs to assist them using assistive devices and monitoring due to non-compliance. On May 21, 2025, at approximately 4:00 PM, LPA Iniguez physically inspected (R#1)’s room. LPA Iniguez observed a motion sensor device by the TV stand that faces (R#1)’s bed. LPA Iniguez asked facility staff to test the motion sensor, and LPA Iniguez observed that it was working properly. On May 21, 2025, at approximately 11:30 AM, they stated that they had always seen that monitor device there during an interview with (R#1) in their room. On May 21, 2025, at approximately 10:00 AM, during an interview with the Administrator (A#1), she stated that (R#1) has a sensor device that allows the facility staff to notice when (R#1) gets in bed or out. In addition, (A#1) stated that the facility staff checks on (R#1)’s monitor devices as needed. On May 21, 2025, at approximately 02:00 PM, during interviews with facility staff (S#1-S#5), (5) out of (5) stated that (R#1) has a monitor device that tells them when (R#1) moves. In addition, (5) out of (5) facility staff stated that they check on (R#1)’s monitor device as needed. Evaluation Report continues LIC 9099-C During this investigation, LPA found did not find sufficient evident to support the above-mentioned allegation(s). Based on the evidence gathered, interviews conducted, and records reviewed, the preponderance of evidence standard has been met; therefore, the above-mentioned allegation(s) are found to be UNSUBSTANTIATED. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur. An exit interview was conducted, and a copy of the Complaint Report was given to Monique Avila/Wellness Director.the state’s words, verbatim · CDSS document, May 21, 2025 · control 11-AS-20250515091559

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.2(a)(4) · Plan of correction due date: Jun 2, 2025

87468.2 Additional Personal Rights of Residents in Privately Operated Facilities (a) In addition to...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 records review and interviews the facility staff are not answering residents’ s pull cords in a timely manner as shown in the Resident Incident Details Report for the period from April 1, 2025, to May 22, 2025. This poses a potential health and safety risk for all the residents in care.the state’s words, verbatim · CDSS document, May 21, 2025

Plan of correction: Licensee will adhere to Title 22 at all times. As plan of correction stated by the faciltiy staff, the facility will re-train all staff regarding the times for the pull alarm system. Proof of training will be submitted to LPA Iniguez via email before due date.

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

On 05/20/2025 Licensing Program Analyst (LPA) Sparkle Day initiated a complaint investigation to Regency Palms Long Beach to deliver the investigation findings for the allegations listed above. LPA met with Administrator Fabiola Marciano (S1) and the purpose of the visit was explained. The investigation consisted of the following: On 2/2/2023, the department conducted the initial visit and toured the physical plant and requested records. On 5/3/2023 and 8/30/2023, the department staff interviewed Staff #1-6 (S1-S6), Residents #2-6 (R2-R6). On 2/7/2023, 2/28/2023, 3/28/2023, 4/25/2023, 5/2/2023, the department interviewed Administrator (A1), Staff #7-8 (S7-S8) and Witness #1-2 (W1-W2). The department obtained and reviewed the following for R1: Needs and Service Plan (dated 10/01/2021, 06/09/2022, 12/09/2022), Residence Assessment Form (dated 09/04/2021), Physicians Report (dated 09/09/2021, 12/14/2022), Fall Risk Assessment (dated 09/24/2021), Incident report (dated 01/07/2023), Long Beach Fire Department incident report (dated 01/07/2023), Death Report (dated 01/07/2023), Death Certificate (dated 01/15/2023). The Investigation revealed the following: Substantiated Allegation: Questionable Death The details of the complaint alleged S1 wheeled R1 into R1 bed room and left R1 unsupervised for an extended amount of time while R1 had a safety belt attached to R1 wheelchair. During this time, R1 aspirated and died. The department conducted interviews with the Administrator (A1) and Staff #1-8. A-1 Carla Mariano confirmed that R#1 was left in a room unsupervised approximately 1.5 hours with her safety belt on and was found slumped over in her wheelchair unresponsive. 8 out of 8 staff confirmed the allegation occurred. The department conducted records review which revealed R1 was admitted to the facility on 9/4/2021 (Resident Assessment Form, dated 9/4/2021) with primary diagnoses which included hypertension, agitation, generalized muscle weakness, and dementia. R1 was dependent with all ADLs, except assistance with feeding. R1 had motor impairment/paralysis in which R1 was wheelchair bound and unable to maneuver without assistance. R1 required assistance with transfer to and from the bed. R1 was noted with fair physical health status (Physician’s Report, dated 12/14/2022). It was also noted resident had diagnosis of dysphagia (Physician’s Report dated 9/7/2021). Based on the department’s review of R1 record there was no documented evidence a care plan to address the use of safety belt on the wheelchair for R1. Also, there was no care plan to address when and how often resident should be monitored on the wheelchair with R1 safety belt fastened. Lastly, there was no care plan to address resident at risk for aspiration/choking due to diagnosis of dysphagia and or any interventions to prevent resident from injuries related to the use of safety belt. The department reviewed the Death Certificate (dated 2/14/2023) which indicated the immediate cause: Possible aspiration. Based on the interviews conducted and records reviewed S1 failed to properly supervise R1 resulting in the death of R1. Based on records review and interviews, the preponderance of evidence standard has been met; therefore, the allegation of “Questionable Death” is found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division 6, Chapter 8 are being cited on the attached LIC 9099D. Regarding the Allegation: Staff did not ensure postural support was used as prescribed. This complaint alleged that staff did not follow doctor’s orders on use of R1 Postural Support (safety belt) which resulted in the resident sliding out of the wheelchair. The department conducted interviews with the Administrator (A1) and Staff #1-8. A1 confirmed the allegation and 8 out of 8 staff confirmed the allegation occurred.. The department received an Unusual Incident/Injury Report from Regency Palms at Long Beach (dated 1/7/2023), indicated: on 1/7/2023 at approx. 11:15 a.m., R1 was observed sliding out of her wheelchair. With no complaints of pain or discomfort. Staff monitored resident and adjust as needed in wheelchair if noted sliding. Records review indicate the following: R1 Physician’s Report (dated 09/27/2021) indicates the safety belt is to keep R1 from sliding or falling from R1's wheelchair. Based on interviews and records reviewed staffed failed to use the postural support as prescribed which resulted in R1 sliding out of her wheelchair. Based on records review and interviews, the preponderance of evidence standard has been met; therefore, the allegation of “Staff did not ensure postural support was used as prescribed.” is found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division 6, Chapter 8 are being cited on the attached LIC 9099D. An $500 immediate civil penalty assessed. At this time, an enhanced civil penalty determination is pending in reference to Health & Safety Code 1569.49(e) Serious Death. Exit interview conducted with Administrator and appeal rights provided. Regarding the Allegation: Staff did not secure resident's medication It is alleged that the facility staff do not secure residents medication resulting in medication (Atorvastatin) being stolen in December 2022. On 8/30/23 at around 12:04pm The department interviewed Staff and residents. 5 of 5 residents denied they have not had any missing medications nor ever running out of medications. 4 of 4 Staff interviewed deny the allegation and state that medications is ordered from the pharmacy and delivered to the facility. The facility staff sign for medications and take to Medication Room where it is locked and secured. No medications has come up missing. The Department observed the medication Mars records for R1 from April 2022 to Jan 2023. Upon review of the medication record of R#1 ,The Department finds that medication was given to R#1 as prescribed by physician. Based upon this investigation, LPA finds that 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 with Administrator.the state’s words, verbatim · CDSS document, May 20, 2025 · control 11-AS-20230201113427

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87411(a) · Plan of correction due date: May 21, 2025

Personnel Requirements- Facility personnel shall at all times be sufficinet in numbers to meet resident needs. In facilities licensed for 16 or more, sufficient support staff shall be employed to ensure provision of personeel assisitance and care as required in Section 87608 This Requirement is not met as evidence by: Based on interviews conducted and records review, Staff #1 failed to provide supervision of R1 while R1 was using a postural support (belt) which resulted in the R1 death.R1 was left unsupervised for over 45 minutes.This posed an immediate health& safety risk to residents in carethe state’s words, verbatim · CDSS document, May 20, 2025

Plan of correction: Licensee will provide a plan to reassess residents to determine staffing needs of the facility. Licensee will submit the plan to Licensing by POC due date. An IMMEDIATE $500.00 CIVIL PENALTY ASSESSED.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87608(a)(1) · Plan of correction due date: May 28, 2025

Postural Supports - Postural supports shall be limited to apliances or devices...used to achieve proper body position..but not limited to, preventing a resident from falling out of chair. This requirement is not met as evidence by: Based on interviews conducted and records reviewed on 1/7/23 resident was observed sliding out of wheelchair due to staff failing to use the prescribed postural support (safety belt). The postural support was ordered to prevent R1 from sliding/falling. This poses an health & safety risk to residents in carethe state’s words, verbatim · CDSS document, May 20, 2025

Plan of correction: Licensee will ensure all employees receive training on Postural support and submit sign in sheets and training materials to LPA by POC date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87466 · Plan of correction due date: May 28, 2025

Observation of the resident_ The Licensee shall ensure that residents are regularly observed for changes in physical,mental ,emotional and social functioning and that appropriate assistance is provided when such observation reveals unmet needs.When changes are observed the licensee shall ensure the changes are documented and brought to the attention of the residents physician and Resposible party. This requirement was not met as evidence by: Based on interviews facility staff were aware of changes in R1 physical limitation and R1 not being able to be left unsupervised. There is no document appraisal documenting these changes. This poses a health & safety risk to residents in carethe state’s words, verbatim · CDSS document, May 20, 2025

Plan of correction: Licensee will have an training on reporting resident changing conditions to appropriate staff and responsible parties. by POC date

Type of visit: Case Management - Deficiencies

This report supersedes, report dated 04/23/2025 to add additional information and additional citations. On 05/08/2025 at 11:15am Licensing Program Analyst (LPA) Zina Brown conducted an unannounced Case Management visit to issue deficiencies found during complaint investigation 11-AS-20250417101102. LPA met with Executive Director, Fabiola Marciano and explained the purpose of the visit. On the following dates, 1/6/2025 and 4/18/2025, the department received video surveillance from a shared residents' room. The videos received were from various angles inside the shared residents' room. The video surveillance also has audio component. On 4/23/2025, LPA conducted an interview with Executive Director (ED) Fabiola Marciano and the ED stated she was aware of the video surveillance in resident rooms and confirmed that no consent forms are on file. The ED also confirmed Regency Palms did not submit to Community Licensing a waiver request for the use of video surveillance in resident rooms. LPA conducted a file review of Resident #1 (R1) – Resident #7 (R7). Review of the Admissions Agreement observed on page 6 under Miscellaneous, which states, "10.9 Due to the privacy of the residents, residents will not have nanny cams in their apartment." Report continues on LIC 809-C Based on the interviews conducted and records reviewed, Regency Palms Long Beach violated residents' personal rights by allowing video surveillance in residents with shared rooms. Regency Palms Long Beach did not adhere to its Plan of Operation by allowing the use of video surveillance in the room of Resident #1 (R1) - Resident #7 (R7). Regency Palms Long Beach failed to comply with Title 22 Regulations and the Evaluator Manual section 2-5800 Guidance on using Video Surveillance. Deficiencies cited under California Code of Regulation Title 22 Division 6 Chapter 8 are being cited on the attached LIC 809-D. Exit interview conducted with Executive Director - Fabiola Marciano and copy of this report was provided with appeal rights.the state’s words, verbatim · CDSS document, May 8, 2025

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87208(a) · Plan of correction due date: Jun 8, 2025

Plan of Operations: The licensee shall have and maintain a current, written definitive plan of operation for the facility. The licensee shall operate the facility in accordance with the terms specified in the plan of operation. . . This requirement is not met as evidenced by: Based on interviews conducted and records review the facility is not following the approved plan of operation by allowing the use of video surveillance in resident rooms. This poses as a personal rights risk to residents in care.the state’s words, verbatim · CDSS document, May 8, 2025

Plan of correction: The licensee will provide the Department with an updated copy of the Admission Agreement as a means to update the facility Plan of Operation on file with the Department by POC due date.

From the deficiency page — Deficiency type: Type B · Section cited: CCR87468.2(a)(1) · Plan of correction due date: Jun 9, 2025

Additional Personal Rights of Residents in All Facilities, residents in privately operated residential care facilities. . . to have a reasonable level of personal privacy in accommodations. This requirement is nor met as evidenced by: Based on interview conducted and record review. . . Residents #1-7 currently have video surveillance with audio component. 5 of 7 residents are in shared rooms where the video surveillance are located. The facility does not have consent forms on file or approved waiver from licensing in compliance with EM 2-5800.the state’s words, verbatim · CDSS document, May 8, 2025

Plan of correction: The licensee will submit a plan that states fully complying with the tems outlined in it's Admission Agreement and all applicable sections in the California Code of Regulations Title 22, Section 87468, regarding the unauthorized video surveillance in residents living areas or other areas . . . where privacy is expected. The facility will not allow the installation or use of video surveillance in residents apartment which will outline the facility Admission Agreement and Plan of Operation filed with DSS by POC due date.

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

On 05/07/2025, Licensing Program Analyst (LPA), Wendy Gibbs, conducted an unannounced complaint visit to the facility listed above. LPA met with Executive Director, Fabiola Marciano, and the purpose of today’s visit was explained. LPA was granted entry into the facility. The investigation consisted of the following: LPA inspected the facility, interviewed Staff S1-S11, interviewed Residents R1-R8, and received documents pertinent to the investigation. The following documents were received and reviewed Staff Roster (dated 04/20/25), Resident Roster (dated 05/02/2025), residentsIdentification and Emergency Information form, Admission Agreement (dated 09/26/2024), Assessments (dated 08/30/2024, 10/05/2024, and 05/07/2025), Physician’s Report (dated 09/09/2024), and Care Plan (dated 09/27/2024, 10/05/2024, and 05/07/2025). The investigation revealed the following: Unsubstantiated Allegation: Staff did not assist resident with care needs in a timely manner. The allegation alleges staff did not assist a resident with putting bottoms on while they were in bed and was not assisted till early morning, hours later. During the facility inspection, LPA observed Caregivers assisting residents in care. LPA observed caregivers assisting residents to the restroom, assisting with incontinence, changing clothing due to spills or accidents, escorting, grooming, and bathing. During record review, LPA received and reviewed Resident R1’s Care Plan dated 10/05/2024, that indicates R1 requires complete assistance with choice of clothing, dressing, and undressing 2 times per day, every day. Resident is unable to self-perform dressing/undressing. Additionally, LPA received and reviewed R1’s 90-Day Assessment dated 10/05/2024 and a Regency Palms Long Beach General Questions Assessment dated 05/07/2025. Both documents indicate Resident R1 “Requires completed assistance with choice of clothing, dressing, and undressing 2 times daily at 7:00 AM and 7:00 PM. During interviews with Staff S1-S11, were asked if residents who require assistance are assisted in a timely manner, eleven (11) out of eleven (11) state residents are assisted in a timely manner. During interviews with Residents R1-R8, were asked if they receive assistance in a timely manner, five (5) out of eight (8) stated staff come right away to assist. Additionally, one (1) out of eight (8) residents stated today was the first time they had to wait for an extended period of time for assistance due to a low battery in the pendant. During the course of the investigation, LPA was unable to find evidence to support the allegation. Although the allegation 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 is unsubstantiated. LPA did not observe or cite any deficiencies during today's visit. An exit interview was conducted with Executive Director, Fabiola Marciano, and a copy of this report was provided.the state’s words, verbatim · CDSS document, May 7, 2025 · control 11-AS-20250428122830

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

On May 2, 2025, the California Department of Social Services Community Care Licensing (CDSS/CCL) Licensing Program Analyst (LPA) Ernand Dabuet conducted an initial unannounced visit to gather information regarding the above allegations. LPA met with Executive Director Fabiola Marciano and explained the purpose of the visit. LPA was granted entry to the facility. The investigation consisted of Interviews, a collection of records, and a tour of the facility. Interviews were conducted with staff members #1 (S1), and resident members #1(R1). List of documents reviewed/obtained Resident Roster (dated 05/01/25), Personnel Report LIC 500 (dated 05/01/25), Provider Communication Form (dated 04/02/25), Unusual Incident Report (dated 05/02/25), and St. Mary’s Medical Records (dated 04/27/25), and other documents pertinent with this complaint. (Evaluation Report continues LIC 9099C) Substantiated INVESTIGATION REVEALED THE FOLLOWING: Allegation #1: Resident had multiple falls in care. The complaint details alleges that Resident #1 (R1) experienced multiple falls while under care. Reports show that (R1), who resides in the memory care unit, has fallen four times in the past two months and has sustained injuries on (R1)'s body. No additional information has been provided regarding this situation. Resident #1 (R1) was admitted to Regency Palms Senior Living on February 22, 2025, as indicated by their Resident Lease Agreement (dated 02/20/25) and Identification and Emergency Information (dated 02/21/25). On March 31, 2025, (R1) experienced a fall while receiving home health care from St. Victoria Home Health. The incident was reported by med-tech staff at 6:00 PM. Subsequently, on April 27, 2025, at 6:40 AM, (R1) encountered another fall that caused head injury. On May 2, 2025, between 09:30 AM and 11:30 AM, the Department interviewed a staff member identified as Staff #1, (S1) the executive director. (S1) confirmed that multiple unwitnessed falls have occurred with (R1) in the past couple of months. (S1) verified the fall dates of March 31, 2025, and April 27, 2025. (S1) claimed that the family representative for (R1) was notified of each incident and received immediate medical attention at St. Mary’s Hospital. It was further stated that (R1) was reassessed with a Resident Assessment on April 29, 2025; however, a fall management plan designed to minimize the risk of falls was not included. On May 2, 2025, between 11:02 AM and 11:10 AM, the Department interviewed a witness identified as Witness #1 (W1), the family representative for (R1). (W1) reported that staff informed (W1) about (R1)’s recent fall on April 27, 2025, which resulted in several injuries. (W1) also mentioned another fall a few weeks earlier, although (W1) could not provide the exact date and time. That previous fall caused bruises around both eyes and (W1) was notified of it. Both incidents required medical attention at St. Mary’s Hospital. On May 2, 2025, between 11:35 AM and 11:45 AM, the Department interviewed a resident identified as Resident #1 (R1). (R1) shared a recent experience of a fall in (R1)'s room that resulted in a head injury, mainly because it occurred in a familiar area of the room. (R1) claimed to have prior falls, but the specifics could not be recalled in detail. (Evaluation Report continues LIC 9099-C) As a result, Resident #1 (R1)’s Provider Communication Form (dated 04/02/25), Unusual Incident Report (dated 05/02/25), and St. Mary’s Medical Records (dated 04/27/25) confirmed (R1) sustained falls on March 31, 2025, and April 27, 2025, with injuries. A review of (R1)’s Resident Assessment (dated 04/29/25) revealed that (R1) was medically assessed after being hospitalized after a fall incident without a fall management plan. The Department observed (R1)'s wound injuries to the left forehead and bruises on the right inside forearm to confirm injuries from the April 27, 2025, fall incident. Based on the information gathered, there is sufficient evidence to support the allegation mentioned above. Allegation #2: Facility failed to report an incident. It is alleged that the facility staff failed to report an incident involving resident #1 (R1). According to reports, the staff did not inform licensing authorities about fall incidents concerning (R1) with written incident reports. On May 2, 2025, between 09:30 AM and 11:30 AM, the Department interviewed a staff member identified as Staff #1, the executive director. (S1) confirmed that multiple unwitnessed falls have occurred with (R1) in the past couple of months. (S1) verified the fall dates of March 31, 2025, and April 27, 2025. (S1) verified that the facility failed to provide a written incident report, Unusual Incident Report LIC 624, for the incident on March 31, 2025, involving (R1) with head injuries from the fall and was admitted to St. Mary’s Hospital. During the investigation, (S1) also informed the Department of seven incidents with facility residents from April 5, 2025, to April 25, 2025, that were not submitted to Community Care Licensing (CCL) as required according to Title 22 Regulations 87211 Reporting Requirements. Based on the information gathered, sufficient evidence supports the allegation mentioned above. Based on observations, interviews, record reviews, and analysis, the preponderance of evidence standard has been met; therefore, the allegations that "Resident had multiple falls in care" and "Facility failed to report an incident." are determined Substantiated. California Code of Regulations, Title 22, Division 6, and Chapter 8 are being cited on the attached LIC 9099-D. An exit interview was conducted, and Executive Director Fabiola Marciano was provided with a copy of this report and appeals rightsthe state’s words, verbatim · CDSS document, May 2, 2025 · control 11-AS-20250501115014

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87463(b) · Plan of correction due date: May 9, 2025

87463 Reappraisals (b) The reappraisal shall document significant changes in the resident's physical, mental, cognitive, behavioral, or functional condition, including those required to be documented as specified in Section 87466, Observation of the Resident. This requirement is not met as evidenced by: Resident #1 had several falls with no Reappraisal to address the significant health changes with a fall management plan in detail. A plan of action needs to be implemented for the resident due to being at high risk for falls. This poses a potential Health, Safety, or Personal Rights risk to persons in care.the state’s words, verbatim · CDSS document, May 2, 2025

Plan of correction: Licensee/Administrator shall read "Title 22, Section 87463 Reappraisals” and send a written statement to CCLD a plan of action no later than the POC due date. The plan is due to the CCLD/El Segundo ASC Office by (5/09/25) fax at 424-544-1016 Attn: Ernand Dabuet.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87211(a)(1)(D) · Plan of correction due date: May 9, 2025

87211 Reporting Requirements (a) Each licensee shall furnish to the licensing agency such reports... (1) A written report shall be submitted to the licensing agency...within seven days of the occurrence...(D) Any incident which threatens the welfare, safety or health of any resident... This requirement is not met as evidenced by:Resident #1 had several falls and failed to submit an SIR to CCL for the 03/31/25 incident. In addition, seven incidents in April 2025 were not submitted to CCL. This poses a potential Health, Safety, or Personal Rights risk to persons in care.the state’s words, verbatim · CDSS document, May 2, 2025

Plan of correction: Licensee/Administrator shall read "Title 22, Section 87211 Reporting Requirements" and send a written statement to CCLD a plan of action no later than the POC due date. The plan is due to the CCLD/El Segundo ASC Office by (5/09/25) fax at 424-544-1016 Attn: Ernand Dabuet.

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

On 04/23/25, Licensing Program Analyst (LPA) Antonine Richard conducted an unannounced complaint investigation regarding the allegation listed above. LPA met with Executive Director Fabiola Marciano, and the purpose of the visit was explained. A tour of the facility was conducted. The investigation consisted of the following: On 04/23/2025, LPA Richard received facility records which consisted of Staff Roster, Client Roster, House Rules, Resident #1 (R1) records, including Physician’s Report, Admission Agreement, Identification and Emergency Information (LIC 601), Resident Appraisal (LIC603), Unusual Incident Reports, and a copy of the Eviction Notice (dated 04/14/25). Reassessment and Needs of Service Plan (dated 04/01/25). Concise Care Group Placement emails (dated 02/14/25 to 04/18/25). Interviews were conducted with three (3) staff (S1-S3), including the Executive Director, and two residents (R1-R2). Continued LIC9099-C Unsubstantiated Regarding the allegation: Licensee initiated the eviction process in retaliation against the resident. It is being alleged that the client received an eviction letter on 04/15/25, to move out of the facility effective date of 05/14/25. On 04/23/25, between 11:00 am to 12:00 pm, LPA Records reviewed of resident #1 R1 indicated that on 04/01/25, the Wellness Director (WD) conducted a reassessment and a needs of service plan that concluded R1 needed a higher level of care and supervision. The Wellness Director indicated that the Power of Attorney (POA) and the family members were aware of the findings of the reassessment and scheduled to meet with the facility on 04/25/25. On 04/23/25, interviewed with the Executive Director, indicated that the facility does not feel they can meet the resident's R1 higher level of care needs; therefore, A 30-day Eviction Notice and supporting documents were faxed to Community Care Licensing on 04/15/25, following the California Code of Regulations, Title 22. Based on interviews and records reviewed, there was not 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 unsubstantiated. There were no deficiencies cited. An exit interview was conducted a copy of the report was provided to the Executive Director, Fabiola Marciano.the state’s words, verbatim · CDSS document, Apr 23, 2025 · control 11-AS-20250417101102

Type of visit: Case Management - Deficiencies

On 04/23/2025 at 10:53am, Licensing Program Analyst (LPA) Zina Brown conducted an unannounced Case Case Management visit to follow up on a deficiency regarding personal rights privacy. LPA met with Executive Director, Fabiola Marciano and explained the purpose of the visit. On January 6, 2025 at 3:57pm, the department received video surveillance (via email request) in regards to an surrounding incident of assault reported to the department between Resident #1 (R1) and Resident #2 (R2) that occurred on 12/30/2024 approximately at 08:27am. Between the hours of 11:15am - 11:20am, LPA interviewed the executive director Fabiola Marciano. Upon interview, executive director stated that five (5) residents currently have video surveillance cameras in their room. A deficiency is being cited based on interview conducted under California Code of Regulation Title 22 Division 6 Chapter 8 are being cited on the attached LIC 809-D. Exit interview conducted with Executive Director - Fabiola Marciano and copy of this report was provided with appeal rights.the state’s words, verbatim · CDSS document, Apr 23, 2025

From the deficiency page — Deficiency type: Type A · Section cited: HSC 87468.2(a)(1) · Plan of correction due date: Jun 22, 2025

Additional Personal Rights of Residents in All Facilities, residents in privately operated residential care facilities. . . to have a reasonable level of personal privacy in accommodations Based on interview, five (5) residents have surveillance video cameras in their residents bedrooms which poses as a personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Apr 23, 2025

Plan of correction: The licensee will submit a plan to the department outlining the steps, the facility will take to ensure compliance with Title 22 regulations by POC due date.

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

On 04/11/2025, Licensing Program Analyst (LPA), Wendy Gibbs, conducted an unannounced subsequent complaint visit. LPA met with Resident Care Coordinator, Robin Walker, 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 toured the facility, interviewed Staff S5-S11, interviewed Residents R2-R8, and received and reviewed additional documents. The following documents were received and reviewed Resident Incontinent List, resident R1 Admission Agreement, and R1’s Care Plan. During an initial visit conducted on 03/26/2025, LPA Dabuet they toured room 302, interviewed Staff S1, and collected records. The following records were received: Facility Staff Roster (dated 03/26/2025), Register of Facility Residents LIC9020 (dated 10/01/2024), Personnel Report LIC 500 (dated 03/20/25), Resident #1 (R1)'s Physician’s Report LIC 602A (dated 01/29/24), Resident Assessment (dated 02/10/24), and Resident Notes (dated 02/24/24 through 03/07/25). The investigation revealed the following: Substantiated Allegation: Staff leaves resident soiled for an extended period of time. The allegation alleges that a resident was left in a soiled pull-up for an extended period of time. During the facility inspection, LPA observed Staff assisting residents to the bathroom, including R1. During record review, LPA received and reviewed the Physician’s Report for R1 dated 12/27/2023, that indicates R1 has a Bladder Impairment that requires pull-ups. Additionally, the Physician’s Report indicates R1 is not Able to Manage Own Toileting Needs. LPA received and reviewed Resident R1’s Assessment dated 02/10/2024 that indicates R1’s Toileting needs consist of the following assistance, Reminders, verbal cueing, Help with bathroom activities and hygiene, and Full assistance with all aspects of bathroom activities and hygiene. R1’s Assessment indicated Enhanced Needs for Toileting that consist of Assistance with morning, bedtime, and nighttime toileting; Unscheduled escort and assistance with toileting; Two-person assistance with toileting. LPA received and reviewed Resident R1’s current Care Summary that indicates for Toileting R1 requires Minimum- Reminders, verbal cuing, and Needs toileting schedule to be followed. R1 requires Assistance with morning and bedtime toileting, Assistance with AM, PM, and nighttime incontinence care. During interviews with Staff S1, S5-S11, were asked how often incontinent residents are changed and/or checked if they need to be changed, eight (8) out of eight (8) indicated residents are assisted with changing or going to the restroom every 30 minutes to 2 hours depending on the resident. Additionally, Staff S5-S11 was asked if they have come onto shift and had a resident who was soiled, two (2) out of seven (7) stated yes, they have come onto shift and had residents soiled. During interviews with Residents R2-R7, were asked if there was a time they were left in soiled pull-ups or diapers for an extended period of time, four (4) out of six (6) stated yes, they have been left in soiled diapers for an extended period of time. During interviews with Witnesses W1 and W2, were asked if they have come and observed their resident in soiled diapers, one (1) out of two (2) stated they have observed their resident in soiled diapers for an extended period of time. During the course of the investigation, LPA was able to find evidence to support the allegation. Based on LPAs observations and 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 Regulation, (Tittle 22, Division 6 & Chapter number 8), are being cited on the attached LIC 9099D. An exit interview was conducted with Resident Care Coordinator, Robin Walker, and a copy of this report and Appeals Rights was provided.the state’s words, verbatim · CDSS document, Apr 11, 2025 · control 11-AS-20250320085632

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87625(b)(3) · Plan of correction due date: Apr 21, 2025

87625 Managed Incontinence (b) In addition to Section 87611, General Requirements for Allowable Health Conditions, the licensee shall be responsible for the following: (3) Ensuring that incontinent residents are kept clean and dry and that the facility remains free of odors from incontinence. Based on interviews and record review the licensee did not ensure Resident R1, R2, R4, R5, and R6 were provided timely incontinent care to ensure they were kept clean and dry.the state’s words, verbatim · CDSS document, Apr 11, 2025

Plan of correction: The Administrator will review regulation 87625 and retrain staff on Incontinent Care and implement a log to document when incontinent care is conducted. The Administrator will email a copy of the training sign in and log for incontinent care to LPA by POC.

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

On 03/12/2025 at 9:05AM, Licensing Program Analyst (LPA), Wendy Gibbs, conducted an unannounced subsequent complaint visit to the facility listed above. LPA met with Executive Director, Fabiola Marciano, and the purpose of today’s visit was explained. LPA was granted entry into the facility. Investigation consisted of the following: During today's visit, LPA attempted to interviewed Resident R1 again, interviewed Residents R9 and R10, additional interviews with Staff S2, S7, and S8, interviewed Staff S9, and conducted additional review of medications and eMAR for residents. During the initial visit on 03/04/2025, LPA toured the facility, interviewed Staff S1-S8, interviewed Residents R1-R8, and received documents pertinent to the investigation. The following documents were received and reviewed: Staff Roster, Resident Roster, Resident Physician’s Report, Resident Physician’s Order, Resident Medication Administration Record (MAR), RPLB Work Order Management, and Med Tech In-Service log. Substantiated Allegation: Staff did not provide medication assistance to resident in care. The details of the complaint alleges staff did not provide resident with their medications. During LPA’s visit on 03/12/2025, LPA reviewed medications with Staff S7 and S8. LPA reviewed the medications for seven (7) residents, LPA observed seven (7) out of seven (7) residents’ medications were not consistent with documentation of medication administration. LPA observed three (3) out of seven (7) residents have medications that are not listed on the eMAR. Additionally, LPA observed three (3) out of seven (7) residents have medication that is listed on the eMAR but there are no medications. During file review, LPA received and reviewed the eMAR for seven (7) residents and observed medications were not properly documented when taken (initialed by Med Tech), refused, or out of the community. During interviews, on 03/04/2025 and 03/12/2025, with Staff S1-S9, were asked if residents are provided their medication as prescribed, ten (10) out of ten (10) stated they provide residents with their medications as prescribed. During interviews, on 03/04/2025 and 03/12/2025, with Residents R1-R10, were asked if staff provide them their medications as prescribed, one (1) out of ten (10) stated they do not receive their medications as prescribed. Allegation: Staff falsified resident’s records. The details of the complaint alleges staff indicated on the Medication Administration Record that a medication was administered to a resident when it was not. During LPA’s visit on 03/12/2025, LPA reviewed the eMAR and medications for seven (7) residents, LPA observed three (3) out of seven (7) residents had medications that were signed off as provided but were still in the bubble pack. During file review, LPA received and reviewed the eMAR for seven (7) residents and observed medications were not properly documented as taken (initialed by Med Tech), refused, out of the community, or other. During interviews, on 03/04/2025 and 03/12/2025, with Staff S1-S10, were asked if staff had signed off that a medication was provided by a Med Tech and it was not provided, four (4) out of nine (9) stated there was an occasion when a Med Tech signed that a medication had been provided by them and it was not. During the course of the investigation, LPA was able to find evidence to support the allegations. Based on LPAs observations and 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 Regulation, (Tittle 22, Division 6 & Chapter number 8), are being cited on the attached LIC 9099D A civil penalty was assessed for a repeat violation within the last 12 months. LPA, Executive Director, and Wellness Director discussed a referral to the Technical Support Program regarding medication management. An exit interview was conducted with Executive Director, Fabiola Marciano, and a copy of this report and the Appeal Rights were provided. Allegation: Staff did not safeguard resident’s personal belongings. The details of the complaint alleges a residents responsible party has seen their Resident’s clothing is missing and being worn by other residents. During LPA’s visit on 03/04/2025 and 03/12/2025, LPA observed a resident on the third floor leave personal belongings in the common room and staff took the item to the resident. During file review, LPA received and reviewed Resident’s R1-R8’s Client/Resident Personal Property and Valuables (LIC621), LPA observed eight (8) out of eight (8) indicated and signed on the form they decline to have their items inventoried. Additionally, LPA received and reviewed the Theft and Loss Policy provided to the Residents that states it is encouraged for residents to fill out the Resident Personal Property and Valuables form. During interviews, on 03/04/2025 and 03/12/2025, with Staff S1-S9, four (4) out of nine (9) stated sometimes residents clothing get mixed up or a resident will take another residents belongings. During interviews, on 03/04/2025 and 03/12/2025, with Residents R1-R10, were asked if they have had any personal belongings that have gone missing, four (4) out of ten (10) stated they have had some of their personal belongings go missing. During the course of the investigation, LPA was unable to find evidence to support the allegation. Although the allegation 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 is unsubstantiated. An exit interview was conducted and a copy of this report was provided.the state’s words, verbatim · CDSS document, Mar 12, 2025 · control 11-AS-20250224150148

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(a)(4) · Plan of correction due date: Mar 13, 2025

87465 Incidental Medical and Dental Care (a) A plan for incidental medical and dental care shall be developed by each facility. The plan shall encourage routine medical and dental care and provide of assistance in obtaining such care, by compliance with the following: (4) The Licensee shall assist residents with self-administered medications as needed. Based on observation and record review Staff failed to ensure medication for 7 out 7 resident 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, Mar 12, 2025

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 87506(a) · Plan of correction due date: Mar 13, 2025

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, R4, and R8 that were signed off as administered.the state’s words, verbatim · CDSS document, Mar 12, 2025

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: Licensee does not maintain facility in good repair

On 03/04/2025 at 8:37AM, Licensing Program Analyst (LPA), Wendy Gibbs, conducted and unannounced complaint visit to the facility listed above. LPA met with Executive Director, Fabiola Marciano, and the purpose of today’s visit was explained. LPA was granted entry into the facility. Investigation consisted of the following: On 03/04/2025, LPA toured the facility, interviewed Staff S1-S8, interviewed Residents R1-R6, and received documents pertinent to the investigation. The following documents were received and reviewed: Staff Roster, Resident Roster, Resident Physician’s Report, Resident Physician’s Order, Resident Medication Administration Record (MAR), RPLB Work Order Management, and Med Tech In-Service log. The investigation revealed the following: Unsubstantiated Allegation: Licensee does not maintain facility in good repair. The details of the complaint alleges the main elevator in the facility, the washer and dryer, and the refrigerator is currently not working. During LPA’s visit on 03/04/2025, LPA measured the following temperatures of the refrigerators and freezer on each floor, on the 8th floor the temperatures were 38-degrees and -1-degrees, on the 7th floor the temperatures were 35-degrees and 0-degrees, on the 6th floor the temperatures were 40-degrees and -3-degrees, on the 5th floor the temperatures were 34-degrees, and -4-degrees, on the 4th floor the temperatures were 35-degrees and -1-degree, on the 3rd floor the temperatures were 36-degrees and -2-degrees, and on the 2nd floor the temperatures were 36-degrees and -1-degree Fahrenheit. LPA observed both elevators operational, a technician from Lift Tech Elevator Services was at the facility to inspect a sound that was reported in the main elevator, and said it is fully functional and operational. During file review, LPA received and reviewed the RPLB Work Order Management and observed on 02/22/2025, a work order was submitted for the third (3rd) floor refrigerator that was not keeping cool and showing a temperature of 60-degrees Fahrenheit. LPA observed the status update of the work order was “Done.” LPA was notified the refrigerator was replaced with another. Additionally, The facility was unable to get the invoices for elevator maintenance and repairs from the main office, but the LPA was able to conduct an interview with the technician from elevator service company. During the visit, LPA met with a technician from Lift Tech Elevator Service, who stated they come out monthly to conduct maintenance to the elevators. Additionally, the technician stated that there have been some instances that when the elevator has gone down they had to wait for parts before they could repair it. During interviews, on 03/04/2025 between 9AM and 2PM, with Staff S1-S8, were asked if there was anything not working properly in the facility, eight (8) out of eight (8) stated the elevator does go down, but is currently working, the washer and dryers work but the dryers take a while to dry items, and refrigerators are currently working. During interviews, on 03/04/2025 at 11AM till 1:30PM, with Residents R1-R6, were asked if there was anything in the facility that is currently not operational, four (4) out of six (6) stated the main elevator goes down once in a while and the water takes a long time to get warm. During the course of the investigation, LPA was unable to find evidence to support the allegation. Although the allegation 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 is unsubstantiated.the state’s words, verbatim · CDSS document, Mar 4, 2025 · control 11-AS-20250224150148

The state marks this report as 4 pages; the online copy we transcribed has 3. You can request the full file from the county licensing office.

Type of visit: Case Management - Deficiencies

On 2/3/2025, the Department of Social Services (DSS) - Community Care Licensing Division (CCLD) staff conducted an unannounced Case Management visit to follow up on a deficiency regarding hot water temperatures. CCLD staff meet with Executive Director, Fabiola Marciano and explained the purpose of the visit. The department toured the facility and tested hot water temperatures in the 8th floor to the 2nd floor (8th to 2nd floors are the only floors with resident rooms). Resident rooms that did not test between 105 degree Fahrenheit (F) to 120 F in hot water temperatures were as follows: Room 602 had a hot water temperature of 104 F; Room 502 had a hot water temperature of 99 F; Room 504 had a hot of 104.2 F; and Room 406 had a hot water temperature of 100.9 F. A civil penalty assessment - failure to correct is being issued. An exit interview was conducted, and a copy of this report was left with the Resident Care Coordinator, Mary Ruffin along with their appeal rights.the state’s words, verbatim · CDSS document, Feb 3, 2025

Allegation investigated: Staff do not secure residents medications.

On 1/06/2025, the Department of Social Services (DSS) - Community Care Licensing Division (CCLD) staff conducted an unannounced subsequent complaint visit at this facility. CCLD staff was greeted by Executive Director, Fabiola Marciano. The investigation consisted of the following: On 12/17/2024, The department interviewed 1 witness and 2 staff. On 12/18/2024, The department interviewed 1 witness. On 12/30/2024, The department interviewed 1 witness. On 1/2/2025 & 1/3/2025, The department reviewed facility records such as “Resident Incident Details Report”, Staff Time Cards, Resident Roster, Employee Roster, Resident Records, etc. On 1/6/2025, The department interviewed 1 witness, 4 residents, and 4 staff. Unsubstantiated The investigation revealed the following: Regarding the allegation “Staff do not secure residents medications”, it is being alleged that staff do not secure medications (for example, medications refused by residents or not consumed by residents) where it is not accessible to residents in care. Interviews conducted revealed the following: 4 out of 4 resident interviews were inconclusive. 2 out 4 witnesses agreed with the allegation. 3 out of 5 staff who work on the Third Floor denied with the allegation. Observations revealed the following: On 12/17/2025, the department toured the Third Floor and did not observe medications. On 1/6/2025, the department toured the Third Floor and did not observe medications. Regarding the 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, and a copy of this report was left with the Executive Director. The investigation revealed the following: Regarding the allegation “Staff do not ensure that residents incontinence needs are met”, it is being alleged that there is a lack of incontinence care for residents in care, especially during nighttime; for example, not checking residents every two hours and/or leaving residents in soiled undergarments and clothing for extended periods of time. Interviews conducted revealed the following: 4 out of 4 resident interviews were inconclusive. 2 out 3 caregivers who work on the Third Floor denied with the allegation. 4 out of 4 witnesses agreed with the allegation. Records reviewed of “Resident Incident Details Report” of Pull Cords on the Third Floor from Rooms 301 to 308 dating from October 2024 to December 2024 revealed the following: · There was 1 incident when the “Duration” took over 3 hours. · There were 3 incidents when the “Duration” took over 2 hours. · There were 9 incidents when the “Duration” took over 1 hour. · There were 2 incidents when the “Duration” took over 50 minutes. · There was 1 incident when the “Duration” took over 40 minutes. · There were 5 incidents when the “Duration” took over 30 minutes. · There were 11 incidents when the “Duration” took over 20 minutes. 13 out of 32 incidents occurred at nighttime from 6 PM to 12 AM. 3 out of the 6 residents of the “Resident Incident Details Report” require incontinence care according to their “Task Administration Record.” * The “Duration” of alert indicates the time staff took to respond and “Reset Device” (reset pull cord device) in residents’ room. The “Duration” (alert) is only turned off when the device is reset. * According to the Executive Director, the response time of staff should be 9 minutes or less. Records reviewed of “Task Administration Record” for the Third Floor of Residents who Require Incontinence Care for the Month of October 2024 & November 2024 revealed the following: 3 out 7 resident “Task Administration Record” for the Month of October 2024 and November 2024 under incontinence care are left blank; staff did not initial on date nor time. Therefore, there is no documented evidence that 3 out 7 residents were provided with incontinence care. 7 out 7 resident “Task Administration Record” for the Month of October 2024 and November 2024 under incontinence care are mostly left blank; staff did not initial on date nor time. Therefore, there is minimal documented evidence that incontinence care was provided to residents in care as required according to their "Task Administration Record." Records reviewed of “Task Administration Record” for Resident 1’s Incontinence Care for the Month of October 2024 & November 2024 state the following: “#14 Continence – Assist w/ Toileting / Changing” “As Needed” missing initials from 10/1/2024 to 10/30/2024 and 11/1/2024 to 11/31/2024. The document states the following: “Instructions: Staff will need to assist resident every 1-2 hours to bathroom or as needed. Resident’s Needs/Preferences: Requires for toileting and is taken to and from bathroom; needs assistance with putting on and changing incontinence supplies, hygiene and/or changing linen…Service Provider Responsibilities: Staff will assist resident every 2 hours each shift or as needed to soil of clothing, hygiene.” Therefore, there is no documented evidence that incontinence care was provided to Resident 1 from 10/1/2024 to 11/1/2024. Regarding the allegation “Staff do not ensure that residents incontinence needs are met”, the preponderance of the evidence standard has been met therefore the allegation is substantiated. Regarding the allegation “Staff do not answer residents call buttons in a timely manner”, it is being alleged that staff members take over twenty minutes to answer residents call buttons (pull cords). Records reviewed of “Resident Incident Details Report” of Pull Cords on the Third Floor from Rooms 301 to 308 dating from October 2024 to December 2024 revealed the following: · There was 1 incident when the “Duration” took over 3 hours. · There were 3 incidents when the “Duration” took over 2 hours. · There were 9 incidents when the “Duration” took over 1 hour. · There were 2 incidents when the “Duration” took over 50 minutes. · There was 1 incident when the “Duration” took over 40 minutes. · There were 5 incidents when the “Duration” took over 30 minutes. · There were 11 incidents when the “Duration” took over 20 minutes. There were 32 incidents where it took staff over 20 minutes to respond to a residents pull cord. * The “Duration” of alert indicates the time staff took to respond and “Reset Device” (reset pull cord device) in residents’ room. The “Duration” (alert) is only turned off when the device is reset. * Interviews conducted revealed the following: According to the Executive Director the response time of staff should be 9 minutes or less. Observations revealed the following: The department observed pull cords in resident bedrooms and resident bathrooms. Regarding the allegation “Staff do not answer residents call buttons in a timely manner”, the preponderance of the evidence standard has been met therefore the allegation is substantiated. Deficiencies are being cited based on records reviewed and interviews conducted in accordance with the California Code of Regulations, Title 22. Deficiencies regarding incontinence care and staff response time. A civil penalty is being assessed due to it being a repeat violation, regarding incontinence care. An exit interview was conducted, and a copy of this report was left with the Executive Director along with their appeal rights.the state’s words, verbatim · CDSS document, Jan 6, 2025 · control 11-AS-20241209161139

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87625(b)(2) · Plan of correction due date: Jan 28, 2025

87625 Managed Incontinence (b) In addition to...the licensee shall be responsible for the following: (2) Ensuring that incontinent residents are checked during those periods of time when they are known to be incontinent, including during the night. This requirement was not met as evidenced by: Based on records reviewed, the facility does have documented evidence that incontinence care was provided to 3 out 7 residents as required by their “Task Administration Record” for the months of 10/2024 and 11/2024; and there is minimal documented evidence that incontinence care was provided to 7 out 7 residents in care as required according to their "Task Administration Record”.the state’s words, verbatim · CDSS document, Jan 6, 2025

Plan of correction: The Executive Director has agreed to retrain staff on Incontinence Care and retrain on how to use and document on the facilities “Task Administration Record”. The Executive Director will email Socorro.Leandro@dss.ca.gov training records.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.2(a)(4) · Plan of correction due date: Jan 28, 2025

87468.2 Additional Personal Rights of Residents in Privately Operated Facilities (a) In addition to...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 records reviewed, staff did not answer residents pull cords in a timely manner. According to “Resident Incident Details Report” of Pull Cords on the Third Floor dating 10/2024 to 11/2024 there were 32 incidents where it took staff over 20 minutes to respond to a residents pull cord.the state’s words, verbatim · CDSS document, Jan 6, 2025

Plan of correction: The Executive Director has agreed to create a plan to ensure that residents pull cords are answered in a timely manner. The Executive Director will email plan to Socorro.Leandro@dss.ca.gov.

Allegation investigated: Staff handled resident in a rough manner.

On 12/17/2024, the Department of Social Services (DSS) - Community Care Licensing Division (CCLD) staff conducted an unannounced subsequent complaint visit at this facility. CCLD staff was greeted by Executive Director, Fabiola Marciano. The investigation consisted of the following: On 12/03/2024, The department interviewed 4 staff, 6 residents, and 4 witnesses, and gathered facility records. On 12/16/2024, The department reviewed facility records and interviews conducted. On 12/17/2024, The department delivered findings. Substantiated Regarding the allegation “Staff handled resident in a rough manner”, it is being alleged that on 11/20/2024 Staff 1 (S1) handled Resident 1 (R1) (who has dementia and wanders) in a rough manner. Interviews conducted revealed the following: Staff 1 indicated that they placed their arms underneath R1’s arm pits and walked behind R1 to take them out of another resident’s room. Witness 2 (W2) indicated that they saw R1 go into another resident’s room and S1 did not redirect R1 but instead S1 took out R1 by holding both hands behind R1’s body. Witness 2 explains that they did not clearly see what happened but is certain that S1 physically removed R1 from the other resident’s room. Witness 1 (W1) indicated that they saw R1 walk into another resident’s room. Witness 1 goes on to explain that S1 grabbed both of R1’s arms behind their body and then pushed out R1 with their upper body. Three staff who were not witnesses of the incident indicated that they heard a similar story of the incident. During interviews conducted with staff, staff gave examples of how to redirect residents with dementia and none of the examples involved physically touching residents. Records reviewed of the Facility "Dementia Care Plan of Operation for Regency Palms Long Beach" state the following: “Respect the Individual: In addition to specific “resident rights” outlined in state regulations, we advocate the following rights for all residents: Freedom from…physical restraints o Freedom to move without being confined including space…3. Special Techniques/programs for managing specific types of behavior. In order to provide optimal care…Agitation…wandering…can become difficult management issues…Appropriate behavioral interventions can include: Offer a snack, sensory stimulation, 1 on 1 interaction…Wandering: daily living skills, walking, dancing…” The Facility “Dementia Care Plan of Operation for Regency Palms Long Beach” provides 20 different examples of redirection when residents are wandering. Moreover, none of these examples indicated physically touching a resident nor physically relocating a resident. Furthermore, S1 did not follow the Facility’s “Dementia Care Plan of Operation for Regency Palms Long Beach” because they indicated they used “physical restraints” by physically removing R1 from a resident's room. S1 did not use “Appropriate behavioral interventions” at outlined in the “Dementia Care Plan of Operation for Regency Palms Long Beach.” Regarding the allegation “Staff handled resident in a rough manner”, the preponderance of the evidence standard has been met therefore the allegation is substantiated. Deficiencies cited based on interviews conducted and record review in accordance with the California Code of Regulations, Title 22. An exit interview was conducted, and a copy of this report was left with the Executive Director along with their appeal rights.the state’s words, verbatim · CDSS document, Dec 17, 2024 · control 11-AS-20241125165223

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.1(a)(3) · Plan of correction due date: Jan 7, 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: (3) To be free from punishment, humiliation, intimidation, abuse, or other actions of a punitive nature...interfering with daily living functions such as...elimination. 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 having S1 physically remove R1 from a resident room. Thus, R1 was not free from punishment, humiliation, physical abuse, or actions that were punitive in nature, which poses a health, safety, and personal rights risks to residents in care.the state’s words, verbatim · CDSS document, Dec 17, 2024

Plan of correction: The Executive Director has agreed to retrain staff on Personal Rights and email proof of correction to Socorro.Leandro@dss.ca.gov.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87705(a-I8) · Plan of correction due date: Jan 7, 2025

87705 Care of Persons with Dementia (a) This section applies to licensees who accept or retain residents diagnosed…to have dementia…(b) In addition to…the plan of operation shall address the needs of residents with dementia, including:…(2) Safety measures to address behaviors such as wandering, aggressive behavior and ingestion of toxic materials…(3) In addition to the on-the-job training…staff who provide direct care to residents with dementia shall receive the following training as appropriate for the job assigned and as evidenced by safe and effective job performance: (4) There is an adequate number of direct care staff to support each resident’s physical, social, emotional, safety and health care needs as identified in his/her current appraisal. (4) Without violating Section 87468, Personal Rights, facility staff shall attempt to redirect a resident who attempts to leave the facility. (5) Residents who continue to indicate a desire to leave the facility following redirection shall be permitted to do so with staff supervision. (6) Without violating Section 87468, Personal Rights, facility staff shall ensure the continued safety of residents if they wander away from the facility…(A) Facility staff shall attempt to redirect any unaccompanied resident(s) leaving the facility. (5) Interior and exterior space shall be available on the facility premises to permit residents with dementia to wander freely and safely. (8) Fire and earthquake drills shall be conducted at least once every three months on each shift and shall include, at a minimum, all direct care staff. 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 not following their Plan of Operation regarding safety measures to address behaviors such as wandering; S1 not redirecting R1 safely; S1 violating Personal Rights during attempted redirection for R1; not allowing R1 to wander freely and safely within the premises.the state’s words, verbatim · CDSS document, Dec 17, 2024

Plan of correction: The Executive Director has agreed to re-read and follow their "Dementia Care Plan of Operation for Regency Palms Long Beach" and CCR87705. The staff has agreed to retrain staff on Care of Persons with Dementia and How to Redirect on Residents with Dementia. The licensee will email proof of correction to Socorro.Leandro@dss.ca.gov.

Type of visit: Case Management - Deficiencies

On 12/17/2024, the Department of Social Services (DSS) - Community Care Licensing Division (CCLD) staff conducted a Case Management visit at this facility to deliver an additional deficiency regarding COMPLAINT CONTROL NUMBER: 11-AS-20241125165223. CCLD staff met with the Executive Director, Fabiola Marciano and explained the purpose of the visit. The investigation revealed the following: On 11/20/2024, Staff 1 (S1) handled a resident in a rough manner. Interviews conducted revealed the following: Two witnesses indicated that they saw S1 handle a resident in a rough manner. The Resident Care Coordinator was informed of the incident on 11/22/2024. The Executive Director was informed of the incident on 11/22/2024. Both the Resident Care Coordinator and the Executive Director indicated that they did not submit an Unusual Incident/Injury Report to CCLD. Records reviewed revealed the following: On 12/03/2024, the Department reviewed CCLD’s El Segundo’s Regional Office files and did not find an Unusual Incident/Injury Report regarding the incident above. A deficiency is being cited based on interviews conducted and record review in accordance with the California Code of Regulations, Title 22. A deficiency regarding Reporting Requirements. An exit interview was conducted, and a copy of this report was left with the Executive Director along with their appeal rights.the state’s words, verbatim · CDSS document, Dec 17, 2024

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87211(a)(1)(D) · Plan of correction due date: Jan 7, 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. (D) Any incident which threatens the welfare, safety or health of any resident, such as psychological abuse of a resident by staff or other residents, or unexplained absence of any resident. This requirement was not meet by evidence by: Based on interviews conducted and record review, the licensee did not comply with section cited above by not submitting a written report to the licensing agency within seven days of the incident that occurred on 11/20/2024.the state’s words, verbatim · CDSS document, Dec 17, 2024

Plan of correction: The Executive Director has agreed to re-read CCR87211 and follow Reporting Requirements, create a plan to follow Reporting Requirements, and retrain staff on how to submit written reports to licensing. The Executive Director has agreed tol submit an Unusual Incident Report to CCLD regarding the incident that occured on 11/20/2024. The licensee will email proof of correction to Socorro.Leandro@dss.ca.gov

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

On 12/16/24, Licensing Program Analyst (LPA) Felisa Shirley conducted a subsequent unannounced visit to this facility. LPA was met by Robin Walker, Resident Care Coordinator, and explained the purpose of the visit is to investigate and deliver findings for the allegations mentioned above. LPA was granted access to the facility. The investigation consisted of the following: On 11/6/24 LPA Felisa Shirley requested, received and reviewed copies of the following records: Staff Roster and Resident Rosters. LPA Shirley requested the following records for R-1, incontinence log, Resident Incident Details Report, (pull cord log), Medication Administration Log (MAR) and Special Incident Reports (SIR’s), emergency information, physician’s report, Preplacement Appraisal Information, After visits forms, Appraisal Needs and Services and internal communications. LPA also interviewed staff 1 thru staff 7 and resident 1 thru resident 7. The investigation revealed the following: Substantiated Allegation: Staff did not adequately assist resident with incontinence care needs in a timely manner. On 11/6/24, LPA Shirley reviewed Appraisal Needs/Services and observed that it states R-1 is incontinent. During review of facility records, specifically incontinence log for R1, incontinence log is dated from 8/2/24 thru 11/4/24, with 4 months of changes entered on one sheet. The dates listed on the log are not consistent. A few dates are listed in order then the date skips to the next month without completing the prior month. On 11/6/2024 LPA observed pull cords in the residents’ rooms. There are pull cords in every apartment unit located in the living room, bedroom and bathrooms. During the interview with S-2 on 11/6/24, LPA was told that residents on the Assisted Living floors also wear call pendants around their necks. LPA was also told by S-2 that the alert resets when units button is pushed. Upon review of facilities pull cord logs, LPA Shirley observed that dates ranged from 8/1/24 thru 11/6/24. Log lists the time call button is pushed by resident as well as the times caregivers respond and reset the call button. Per the log, there were 51 alerts with response times over 30 minutes, 8 alerts with response times over an hour and on 8/3/2024 the log lists that a pull cord was pushed at 4:46am and was lasted for a duration of three hours, forty-seven minutes and eighteen seconds, which was the longest time of delayed response from caregivers. LPA Shirley interviewed staff-1 thru staff-7 (S-1 thru S-7). LPA asked if staff assist residents with incontinence needs in a timely manner. Of those interviewed, 6 out of 7 staff answered yes, and 1 answered no. LPA interviewed resident-1 thru resident-7 (R-1 thru R-7). LPA asked residents if staff assist them with incontinence needs in a Con'd on 9099-C timely manner. Of those interviewed, 2 out of 7 answered yes, 1 answered no and 4 do not need incontinence assistance. Based on interviews that were 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.the state’s words, verbatim · CDSS document, Dec 16, 2024 · control 11-AS-20241031113210

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87625(b)(2) · Plan of correction due date: Dec 30, 2024

87625 Managed Incontinence (b) In addition to Section 87611, General Requirements for Allowable Health Conditions, the licensee shall be responsible for the following: 2) Ensuring that incontinent residents are checked during those periods of time when they are known to be incontinent, including during the night. This requirement was not met as evidenced by: Based on interviews and records review, facility staff did not assist R-1 during the period of time when resident is known to be incontinent which poses a possible health and safety risk to persons in care.the state’s words, verbatim · CDSS document, Dec 16, 2024

Plan of correction: The Adminstrator shall implement a system designed to answer pull cord alerts faster. Administrator will delegate the pull cord alerts over to the Med Techs which she feels will get a faster response in getting those alerts over to the caregivers to be of assistance to residents in care. Please send copies of Plan of Corrections to LPA Felisa Shirley by email at felisa.shirley@dss.ca.gov or by fax to (424)544-1016 by POC date of 12/30/24.

Type of visit: Case Management - Deficiencies

On 12/16/24, Licensing Program Analyst (LPA) Felisa Shirley visited this facility to investigate a complaint and upon investigation learned that facility staff are not answering the pull cord alert which alerts staffs attention to residents requesting for assistance in a timely manner. The LPA met with Robin Walker, Resident Care Coordinator, and the purpose for the visit was discussed. LPA Shirley interviewed 7 staff members and 7 residents. Deficiencies cited under California Code of Regulations Title 22 Exit Interview Conducted with Administrator Fabiola Mariano.the state’s words, verbatim · CDSS document, Dec 16, 2024

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87468.2(a) · Plan of correction due date: Dec 30, 2024

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… This requirement was not met as evidenced by: Based on interviews and records review, facility staff did not assist R-1 after being alerted in a timely manner which poses a possible health and safety risk to persons in care.the state’s words, verbatim · CDSS document, Dec 16, 2024

Plan of correction: The Adminstrator shall implement a system designed to answer pull cord alerts faster. Administrator will delegate the pull cord alerts over to the Med Techs which she feels will get a faster response in getting those alerts over to the caregivers to be of assistance to residents in care. Please send copies of Plan of Corrections to LPA Felisa Shirley by email at felisa.shirley@dss.ca.gov or by fax to (424)544-1016 by POC date of 12/30/24.

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

On 11/18/2024 at 9:17am, Licensing Program Analyst (LPA) Zina Brown and Licensing Program Manager (LPM) Janae Hammond initiated a unannounced complaint investigation for the allegation listed above. During today’s visit, LPA and LPM met with Fabiola Mariano Administrator. The investigation consisted of the following: On 11/18/2024, LPA and LPM interviewed Administrator (A1), Staff # 1-3 (S1 – S3) and Residents #1-6 (R1 – R6) and 8 medication administration record review. LPA also obtained copies of staff roster (dated on 10/29/2024), resident roster (on 11/18/2024), and 8 medication administration records (for the month of November) and staff training in medication administration (dated 08/06/2024). Report continues on LIC 9099-C. Substantiated The investigation revealed the following: Allegation: Staff did not administer medication to residents as prescribed. On 11/18/2024 between the hours of 11:44am – 12:07 pm, LPA interviewed Administrator (A1) and Staff # 1 – Staff #4 regarding the allegation. 2 out of the 4 staff interviews, confirmed the allegation and 2 of the 4 staff interviewed denied the allegation. On 11/18/2024 between the hours 11:05am – 11:26 am interviewed residents #1 - #6, 3 out of the 6 residents confirmed the allegation and 3 out of 6 residents denied being aware of the allegations. On 11/18/2024 at 1:15pm, LPA conducted 8 medication administration record review whihc revealed the following: for 1 out 8 residents medication review, revealed the facility does not have the residents prescribed medication for trazadone, senna and setraline. 7 out 8 resident medication review revealed, the medication administration record is not signed that resident was administrated the medication for various dates. Substantiated: 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. California Code of Regulations, Title 22, Division 6 and Chapter 8 are being cited on the attached LIC 9099D. Civil penalty is assessed in the account of $250 for repeat violation with 12 month period. Exit interview conducted with Fabiola Mariano (Administrator) and copy of the report and appeal rights were provided.the state’s words, verbatim · CDSS document, Nov 18, 2024 · control 11-AS-20241112103247

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(a)(4) · Plan of correction due date: Nov 19, 2024

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 8 out 8 resident 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, Nov 18, 2024

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.

Allegation investigated: Staff neglect resulted in resident falling.

On 11/6/24, Licensing Program Analyst (LPA) Felisa Shirley conducted an unannounced subsequent visit to this facility. LPA was met by Robin Walker, Resident Care Coordinator, and explained the purpose of the visit is to investigate and deliver findings for the allegations mentioned above. LPA was granted access to the facility. The investigation consisted of the following: On 11/6/24 LPA Felisa Shirley requested and received copies of the following records: Staff Roster, Resident Rosters, incontinence logs, emergency push logs, MAR and SIR’s. LPA Felisa Shirley reviewed resident’s logs and received copies of identification and emergency information, physician’s report, Preplacement Appraisal Information, After visits forms, Appraisal Needs and Services and internal communications. The investigation revealed the following: Con'd on 809-C Unsubstantiated Allegation: Staff neglect resulted in resident falling. On 11/6/24, LPA Felisa Shirley reviewed resident’s facility file. Upon review of C-1’s Physicians Report, C-1 is a fall risk. LPA reviewed a Special Incident Report in which on 10/31/24, C-1 began slipping from soap during a shower. C-1 began sliding so caregiver guided resident to a sitting position on the floor of the shower. Med Tech and Wellness director were notified. C-1’s family was also notified that resident was assessed, there was no fall, and he was not in any danger. Family stated that they did not see any need to send him to the ER. On 11/6/24, LPA toured facility and went to client’s room and observed that there was no plastic chuck placed on top of the sheets. LPA did observe a large bath towel folded and placed on the bed sheets, on the side of the bed that C-1 sleeps on to avoid sliding and falls. LPA did not observe any special incident reports that reported any falls. LPA Shirley interviewed staff-1 thru staff-7 (S-1 thru S-7). LPA asked, does staff neglect result in resident falls? Of those interviewed, 7 out of 7 answered no. LPA interviewed Client-1 thru Client-7 (C-1 thru C-7). LPA asked, have you had any falls due to staff neglect?” Of those interviewed, 7 out of 7 answered no. Based on information gathered, LPA did not find sufficient evidence to support the allegation “Staff neglect resulted in resident falling,” therefore the allegation is unsubstantiated.the state’s words, verbatim · CDSS document, Nov 6, 2024 · control 11-AS-20241031113210

The state marks this report as 3 pages; the online copy we transcribed has 2. You can request the full file from the county licensing office.

Type of visit: Required - 1 Year

On 10/31/2024 at 08:12am, 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 Fabiola Marciano, Executive Director 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 35 residents are diagnosed with dementia, 4 residents receiving home health, 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 liability insurance is current and expires 05/01/2025. 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 (118.0 F-120 F). Resident bath towels, toiletries and personal hygiene supplies were adequately stocked. Common areas were clean and clear of hazards; doorways were free of obstructions. Each floor has its own medication room. LPA Brown & LPA Villegas conducted a records review of (10) client records, (9) staff records, (10) clients Personal & Incidental Records and reviewed the facility disaster plan. All client & Staff records were complete. The facility disaster plan was current and in compliance with Title 22 at the time of visit. LPA reviewed (3) Client Medication Administration Records and did not observed any discrepancies at the time of visit. Report continues on LIC-809 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. During todays visit LPA did not observe any deficiencies. An exit interview was conducted with Fabiola Mariano, Executive Director.the state’s words, verbatim · CDSS document, Oct 31, 2024

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

On 10/02/24, Licensing Program Analyst (LPA) Troy Watson and Licensing Program Manager (LPM) Stephanie Cifuentes, conducted an unannounced complaint visit at this facility and were greeted by the Executive Director Fabiola Mariano and Wellness Director Robin Walker. LPA explained the purpose of the visit is to gather information regarding the above allegations. And was allowed entrance into the facility. The investigation consisted of the following: On 10/02/2024 LPA interviewed staff #1-#6 (S1-S6) and interviewed residents #1-#5 (R1-R5). LPA Watson requested, received, and reviewed Physician's Reports, Medication Administration Records (MARs) and Admission Agreements for R1-R5. Continued on 9099-C Substantiated The allegations revealed the following: Allegation: Staff did not give resident medication On 10/02/24 the Department audited the facilities Medication Administration Records (MAR) dated September 2024. Documents were reviewed for 5 residents, and 5 out of 5 MAR’s showed residents did not receive medication several days in September 2024. All MAR’s reviewed show blanks spaces and no notation that medication was refused, or resident was out of the community for several different dates and times. On 10/02/24 LPA Watson interviewed staff #1-#6 (S1-S6), of those interviewed 2 out of 6 stated they believed residents had not received medications. On 10/02/24 LPA Watson interviewed residents #1-#5 (R1-R5). Of those interviewed, 5 out of 6 stated they believed they had not received medications. Based on evidence gathered, interviews conducted, records reviewed, the preponderance of evidence standard has been met; therefore, the allegation of " Staff did not give resident medication " is found to be found to be SUBSTANTIATED. Allegation: Staff are not documenting medications properly On 10/02/24 the Department audited the facilities Medication Administration Records (MAR) dated September 2024. Documents were reviewed for 5 residents, and 5 out of 5 MAR’s showed blank spaces throughout the record. Per the charting codes given on the eMar, there is a code for each action, so there should be no blanks spaces for daily medications. Continued on 9099-C On 10/02/24 LPA Watson interviewed staff #1-#6 (S1-S6) and of those interviewed 1 out of 6 stated the MAR had not been documented properly. LPA Watson asked the additional question of what blank spaces meant on the MAR, and of those interviewed, 4 out of 6 stated blank spaces meant the medications were not properly documented. On 10/02/24 LPA Watson interviewed residents #1-#5 (R1-R5). Of those interviewed, 3 out of 6 stated they believed there medications had not been properly documented. Based on evidence gathered, interviews conducted, records reviewed, the preponderance of evidence standard has been met; therefore, the allegation of " Staff are not documenting medications properly" is found to be found to be SUBSTANTIATED. According to the California Code of Regulations (Title 22, Division 6, Chapter 8), the following deficiencies have been observed and a citation issued (ref. LIC 9099D). An exit interview has been conducted and a copy of the Complaint Report and Appeal Rights was provided to the Executive Director Fabiola Mariano.the state’s words, verbatim · CDSS document, Oct 2, 2024 · control 11-AS-20240925105558

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87465(a)(4) · Plan of correction due date: Oct 30, 2024

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: On 10/2/2024 LPA Troy Watson observed on eMAR that medications had been missed for residents 1-5 for month of September 2024. This is a potential health and safety risk to clients in care.the state’s words, verbatim · CDSS document, Oct 2, 2024

Plan of correction: Administrator will conduct staff medication training through Relias and with local pharmacy. Facility will provide copies of transcripts to CCL via email/fax by POC due dates.

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87506(a) · Plan of correction due date: Oct 30, 2024

Resident Records 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. This requirment has not been met as evidenced by: On 10/2/2024 LPA Troy Watson observed that eMAR that sections had been left blank, when they should have a charting code. This is a potential health and safety risk to clients in care.the state’s words, verbatim · CDSS document, Oct 2, 2024

Plan of correction: Wellness director will check eMAR at end of every shift to verify medication is properly documents. Facility will provide POC via email/fax by due date.

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

On 08/14/24, Licensing Program Analyst (LPA), Wendy Gibbs, conducted an unannounced 10-day complaint visit to the facility listed above. LPA met with Administrator, Fabiola Marciano, and the purpose of today’s visit was explained. During today’s visit LPA toured the facility, interviewed Staff S1-S12, interviewed Residents R1-R10, and received documents pertinent to the investigation. The following documents were received and reviewed, Staff Roster, Resident Roster, staffs signed Mandated Reporting, staff training logs regarding resident care, Staff Expectations and Handbook, resident Physician’s Report, and resident Needs and Service Plans. The investigation revealed the following: Continued On LIC9099-C Unsubstantiated Allegation: Staff do not treat residents with respect The complaint allegation alleges that staff are cussing at residents. During record review, LPA received and reviewed staffs signed Statement Acknowledging Requirement to Report Suspected Abuse of Dependent Adults and Elders. Additionally, LPA received and reviewed staff training and in-services regarding care for residents, including talking to residents, resident care plans, caring for residents with dementia, and abuse reporting. LPA reviewed and received a copy of the facility’s Employee Handbook, that states under Resident Relations on page 23, Employees must be always be courteous and respectful to Residents and fellow employees. During the facility tour LPA observed interactions between caregivers and residents. During interviews with Staff S1-S12, were asked if they have or have heard a staff cussing at residents, twelve (12) out of twelve (12) stated they have not heard staff cussing or speaking inappropriately to residents. Additionally, Staff S1-S12 were asked if residents are treated and spoken to respectfully, twelve (12) out of twelve (12) stated residents are treated and spoken to respectfully. During interviews with Staff S1 and S2, stated they have not heard staff speaking to residents inappropriately, but have observed or heard of staff speaking inappropriately and cussing to each other while working on the floor. S1 and S2 stated they remind the staff this is not their home and there are residents present and to be mindful about what you say and please speak appropriately while at work. Additionally, staff were asked what they would do if they heard staff cussing at a resident, twelve (12) out of twelve (12) stated they would report it. (2) Continued on LIC9099-C During interviews with Residents R1-R10, were asked if they have heard or have had staff cuss or speak to them inappropriately, ten (10) out of ten (10) stated they have not heard, nor have they had staff cuss or speak inappropriately. Unsubstantiated During the course of the investigation, LPA was unable to find evidence to support the allegation. Although the allegation 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 is unsubstantiated. Allegation: Staff handle residents in a rough manner The complaint allegation alleges that staff grab residents roughly and handle them roughly. During record review, LPA received and reviewed staffs signed Statement Acknowledging Requirement to Report Suspected Abuse of Dependent Adults and Elders. Additionally, LPA received and reviewed staff training and in-services regarding care for residents, including talking to residents, transferring resident safely, resident care plans, caring for residents with dementia, and abuse reporting. LPA received and reviewed a copy of the Employee Handbook and Job Description, that states on page 23, residents are to be treated courteously and always given proper attention. During the facility tour, LPA observed caregivers assisting residents with transferring. During interviews with Staff S1-S12, were asked if they have or if they have observed staff handling residents in a rough manner, twelve (12) out of twelve (12) stated they have not observed a staff handling a resident in a rough manner. (3) Continued on LIC9099-C Additionally, staff were asked what they would do if they observed staff handling residents in a rough manner, twelve (12) out of twelve (12) stated they would report it to management. During interviews with Residents R1-R10, were asked if they have been or have observed staff handle a resident in a rough manner, ten (10) out of ten (10) stated they have not observed, nor have they been handled in a rough manner by staff. Unsubstantiated During the course of the investigation, LPA was unable to find evidence to support the allegation. Although the allegation 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 is unsubstantiated. During today’s visit, no deficiencies were observed or cited. And exit interview was conducted with Administrator, Fabiola Marciano, and a copy of this report was provided.the state’s words, verbatim · CDSS document, Aug 14, 2024 · control 11-AS-20240808145624

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

This report supersedes the report dated 04/17/2024, the purpose of this amendment is to provide clarification regarding staff interviews and to provide correct investigation findings for allegation "Staff did not seek timely medical care for resident." from Unsubstantiated to Substantiated. On 04/17/2024 Licensing Program Analyst (LPA) Jose Calderon conducted an unannounced visit to the facility Regency Palms Long Beach and was greeted by Director Fabiola Marciano (S3). LPA Jose Calderon spoke to S3 prior to entering the facility to conduct a risk assessment. LPA Jose Calderon explained the purpose of this visit is to deliver the findings pertaining to the above-mentioned allegations. The investigation consisted of the following: LPA Jose Calderon interviewed Administrator (A1), resident (R1-R10), staff (S1-S3), witness (W1). This interview was conducted on 04/02/2024, 04/03/2024 and 04/17/2024. LPA Calderon obtained and reviewed copies of the following: Physician report (date 01/09/2024), Incident report (date 03/22/2024), resident notes (date 03/21/2024 to 04/01/2024), Shower logs (date 03/22/2024), body check analysis form (date 02/21/2024, 02/23/2024 and 02/27/2024) for R1 and Inservice training for staff (date 03/23/2024). The investigation revealed the following: Substantiated Regarding Allegation: Staff did not seek timely medical care for resident. This complaint alleged that staff did not seek timely medical care for R1. A1 states that A1 understands that R1 did fall and somehow injured R1 right arm. A1 states that all staff are trained to give aid to a resident that is injured. S1 states that R1 grabbed the bathroom sink and somehow cut R1 right arm. S1 states that S1 was working alone and had 12 other residents to take care of. S1 states that S1 forgot to call the Med teck and care for the wound. S1 states that 1 hour passed until the med teck took care of the injury to R1 right arm. S2 states that S2 received a call from S3 regarding R1 injury. S2 states that S2 went to R1 room and asked staff what happened to R1 arm. S2 states that S2 was told that R1 lost balance and injured R1 arm on the bathroom sink. S2 states that S2 generated an incident report and called R1 family and Wellbe Home Health Care. S3 states that S3 was made aware of the situation and called S2 to take care of R1 wound. S3 states that S1 forgot to call the med teck and additional training would be provided to staff. R1 does not remember the incident that happened on 03/22/2024. 9 out of 10 residents states that staff take care of resident medical needs in a timely manner. Reviewed the in-service training (date 03/23/2024), training on what to do if a resident refuses to take a shower and what to do if the resident is injured. Reviewed incident report (date 03/22/2024), incident happened around 11:30am on 03/22/2024. R1 lost balance and injured R1 right arm. LPA Calderon interviewed W1, who states that W1 witnessed R1 had an injury to R1 right arm. W1 states that W1 asked S1 to call S2 to treat R1 arm. W1 states that S2 did arrive and treated R1 injury. Based on LPA Calderon observations and interviews which were conducted and the records that were reviewed, the preponderance of evidence standard has been met, therefore the above allegations “Staff did not seek timely medical care for resident” is found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division 6 are cited on the attached LIC 9099D. An exit interview was conducted, and plans of corrections were developed. A copy of the Complaint Report and the appeals rights was provided to the DIRECTOR FABIOLA MARCIANO (S3). Regarding Allegation #1: Staff forced resident to shower. This complaint alleged staff forced resident to take a shower. A1 states no staff forces a resident to take a shower. A1 states that if a resident refuses to take a shower staff try 3 or 4 times to give the resident a shower. A1 states that R1 has health issues and refuses to take a shower. A1 states that all staff are given training on how to care for a resident that refuses to take a shower. S1 states that R1 was scheduled for a shower. S1 states that R1 grabbed the bathroom sink and appears to be falling. S1 states that S1 put S1 arms around R1 waist and picked R1 up. S1 states that S1 put R1 in the shower and R1 calmed down. S1 states that R1 has health issues. S3 states that all S3 staff are trained not to force a resident to take a shower. S3 states that R1 would be given 3 chances to change R1 mind and if R1 refuses to take a shower an incident report is generated and R1 family would be called. S3 states that S1 did not force R1 into the shower. R1 does not remember the incident that happened on 03/22/2024. 9 out of 10 residents state that staff have never forced residents to take a shower if residents did not want to take a shower. Reviewed physician report (date 01/09/2024), R1 needs help undressing and taking a shower. Reviewed the shower logs (date 03/22/2024) R1 was schedule for 3 showers per week. Reviewed the in-service training (date 03/23/2024), no staff is to force a resident to take a shower. LPA Calderon interviewed W1, who states that R1 advised W1 that staff had forced R1 to take a shower. Regarding Allegation #2: Staff handled resident in a rough manner. This complaint alleged staff handled R1 in a rough manner. A1 states that no staff handles any resident roughly. A1 states that most resident have health issues and A1 staff are trained to handle resident with care. S1 states that S1 has worked with R1 for a long time and R1 was undressed for a shower. S1 states that R1 grabbed at the bathroom sink and appeared to be falling. S1 states that S1 grabbed at R1 waist to prevent R1 from falling to the floor. S1 states that S1 prevented R1 from falling. S1 states that S1 would not handle any resident in a rough manner. S3 states that all staff are given training on how to care for residents with health conditions. S3 states that no staff would handle a resident in a rough manner. R1 could not remember the incident that happened on 03/22/2024 but did show LPA Calderon R1 right arm which appeared to be not injured. 9 out of 10 residents state that staff treat them with respect and have never grabbed resident in a rough manner. LPA Calderon observed staff and residents doing daily exercises and LPA Calderon did not see staff treat any resident in a rough manner. Based on interviews and supporting documentation, 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 allegations of “staff forced resident to shower”, “staff handled resident in a rough manner” is found to be UNSUBSTANTIATED. An exit interview was conducted, and a copy of the Complaint Report was provided to the DIRECTOR FABIOLA MARCIANO (S3).the state’s words, verbatim · CDSS document, May 1, 2024 · control 11-AS-20240325160311

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87466 · Plan of correction due date: May 10, 2024

87466 Observation of the Resident. The licensee shall ensure that residents are regularly observed for changes in physical, mental, emotional and social functioning and that appropriate assistance is provided....any. This requirement is not met as evidenced by: Based on interviews, and record review, the licensee did not ensure that appropriate assistance was provided to R1. On 10/02/2023 S1 did not seek timely medical care to R1. This poses a health and safety risk to residents in care.the state’s words, verbatim · CDSS document, May 1, 2024

Plan of correction: Administrator will provide additional training regarding title 22 regulations 87466 "Observation of the resident". Plan of correction will be sent to LPA Calderon via email.

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

On 03/11/24, Licensing Program Analyst (LPA), Wendy Gibbs, conducted an unannounced visit to the facility listed above to deliver finding for the allegation listed above. LPA met with Executive Director, Kenia Padilla-Sanchez, and explained the purpose of today’s visit. On a previous visit conducted on 09/06/23, LPA Iniguez conducted the initial 10-day visit. During that visit LPA conducted a facility tour, and received copies of the Resident’s (R1) Admission Agreement, Resident Personal Property and Valuables (LIC621), Theft and Loss Policy, and Resident Handbook. LPA Gibbs conducted staff( S1-S4) and Residents (R2-R6). The investigation revealed the following Unsubstantiated Allegation: Facility staff failed to safeguard resident’s belongings. It is alleged that Resident R1’s jewelry and other personal items remain unaccounted for after the death of R1. During the course of the investigation, LPA received and reviewed the Resident’s (R1) Admission Agreement and Resident Personal Property and Valuables form (LIC621). Upon review of the Resident Personal Property and Valuables sheet, there was no jewelry of any kind listed or documented coming into the facility with R1. Upon review of the Residents (R1) Admission Agreement, it states to “Keep expensive jewelry or other priceless heirlooms at home” and is “recommended that valuable items not be brought into the facility.” During interviews with Staff (S1- S4) four (4) out of four (4) stated they had not observed R1 wearing jewelry or in possession of jewelry while residing at the facility. During an interview with Executive Director S1, was asked what the procedure was after R1 passed, S1 stated once the remains are removed the doors are locked till the Responsible Party is able to come pick up the belongings. S1 stated that R1's Conservator came on 08/25/23 to pack up the personal items of R1 and send them to R1's daughter and that R1's son came to pick up remaining items left in R1's room. During interviews with Residents (R2-R6) they were asked if they have had any items go missing from their room, five (5) out of five (5) stated they have had not items go missing and if they did, they usually find them either in their room, laundry, or somewhere in the facility. During the course of the investigation, LPA was unable to find any evidence supporting the allegation. Although the allegation may have happened or is valid, there is no preponderance of evidence to prove the above allegation did or did not occur, therefore the allegation is unsubstantiated. No deficiencies were observed or cited during today’s visit. LPA conducted an exit interview with Executive Director, Kenia Padilla, and a copy of this report was emailed due to technical issues with LPA's printer.the state’s words, verbatim · CDSS document, Mar 11, 2024 · control 11-AS-20230828133526

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

On 03/11/24, Licensing Program Analyst (LPA), Wendy Gibbs, conducted an unannounced visit to the facility listed above to deliver finding for the allegation listed above. LPA met with Executive Director, Kenia Padilla-Sanchez, and explained the purpose of today’s visit. On a previous visit conducted on 08/24/23, LPA toured the facility, interviewed Staff (S1-S4), interviewed Residents (R2-R6) received, and reviewed Resident R1’s medical records, incident reports, nurse notes, staff notes, doctor visit reports, doctor’s orders, hospital discharge papers, DNR, Advanced Health Care Directive, and all legal documents. The investigation revealed the following: Continued on LIC9099-C Unsubstantiated Allegation: Facility failed to follow resident’s Advanced Health Care Directive. It is alleged the facility was not providing information to an Agent, on the Advanced Health Care Directive, regarding a resident’s care in 2019. During the file review of R1’s resident file, LPA reviewed the Identification and Emergency Information (LIC601) licensing form. LPA found only (1) contact listed on this form. The initial form was filled out on 11/08/18 and signed by R1 upon admission. During file review, LPA observed R1’s Advance Health Care Directive listed (2) emergency contacts (co-agents). Upon additional review if the Advance Health Care Directive, states that the two listed “shall make decisions for me in accordance with what my agent determines to be in my best interest” (pg.2). During reviews of Resident R1’s Service Notes, LPA observed that R1's daughter was informed of incidents in 2019. LPA also observed a note which indicates that former Director of Wellness Meriza De La Cruz got clarification from R1's fiduciary about R1's Advance Health Care Directive 0n 05/02/19. Fiduciary clarified to facility staff that both R1's son and daughter are on her Advance Health Care Directive and that if there is a major medical condition R1's son will respond right away as he lives a few minutes away from the facility and R1's daughter lives in Northern California. LPA observed in the notes that the daughter was added to the Identification and Emergency Information form as well as the fiduciary per the daughter’s request. Additionally, LPA observed that R1’s son and daughter were notified regarding care and treatment of R1. During interviews with Staff (S1-S4) four (4) out of four (4) stated if there are co-agents listed on the Advanced Health Care Directive, they notify both agents Continued LIC9099-C regarding health-related matters in an emergency. Additionally, LPA found R1 had a fiduciary conservator who was notified when R1 required medical treatment. LPA conducted interviews with staff (S1-S3), and three (3) out of three (3) staff members stated they contacted the fiduciary regarding transportation, appointments, treatments, and medications that required a co-pay. S1 stated the facility is does not provide medical treatment of any kind, nor makes medical decisions for a resident, that is between the medical team and the family. S1 stated they will contact the hospital to check on the status of the resident but does not receive information on their care nor treatment while they are there, and the only information they receive is the discharge orders and updated medications. The facility does assist in making the follow-up appointments which they would contact the closest contact listed that could assist in transporting the resident or the fiduciary regarding arranging for transportation for the resident. LPA observed in the service notes all calls to the fiduciary, and R1’s son was regarding transportation, scheduling appointments, medication refills, and pick-ups, not about care or treatment. Although the allegation 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 is unsubstantiated. Allegation: Facility staff falsifying records It is alleged the facility is falsifying communication records. During interviews with staff (S1-S4), LPA asked if staff has falsified any resident records,four (4) out of four (4) stated staff have not falsified any documents and are unaware of Continued on LIC9099-C any other staff falsifying resident documents. During interviews with Residents (R2-R6) they were asked if they had any knowledge of staff falsifying resident records, five (5) out of five (5) Residents stated they have no knowledge of that occurring. LPA conducted a review of communication notes in R1’s Service Record and was unable to find records appearing to be falsified. Although the allegation 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 is unsubstantiated. No deficiencies were observed or cited during today’s visit. LPA conducted an exit interview with Executive Director, Kenia Padilla, and a copy of this report was emailed due to technical issues with LPA's printer.the state’s words, verbatim · CDSS document, Mar 11, 2024 · control 11-AS-20230815161749

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

On 03/11/24, Licensing Program Analyst (LPA), Wendy Gibbs, conducted an unannounced visit to the facility listed above to deliver findings for the allegation listed above. LPA met with Executive Director, Kenia Padilla-Sanchez, and explained the purpose of today’s visit. During a previous visit conducted on 08/09/23, LPA toured the facility, interviewed Staff (S1-S4), interviewed residents (R2-R6) received, and reviewed the following documents Resident’s Admission Packet, Resident Power of Attorney paperwork, Physicians Report, Resident Service Plan, ID/Emergency Information Sheet, and Preplacement Appraisal information. The investigation revealed the following: Continued on LIC9099-C Unsubstantiated Allegation: Facility failed to obtain resident’s representative admission agreement signature at the time of and as a condition of admission. It has been alleged that the appointed fiduciary Power of Attorney signed the admitting documents as the Responsible Person. During the course of the investigation, LPA reviewed the Resident’s (R1) admission agreement, and in that agreement states the services that will be provided by the facility and the cost and additional fees for those services provided. Additionally on page 22 of the Admission Agreement titled Responsible Person Agreement states, “the responsible person signing is responsible payor and guarantor will be responsible for payment of all fees due under or arising from this Agreement.” The admission agreement was signed by the Resident’s (R1) fiduciary Power of Attorney, who was responsible for handling the Resident (R1) finances and ensuring all fees and services were paid for. During an interview with the Executive Director S1, stated when there is an Advanced Healthcare Directive and/or fiduciary, we review the documents pertaining to who has the authority to make medical and financial decisions. We ask to be provided with documents regarding who has the authority to made medical decisions and financial decisions. During the course of the investigation, LPA was unable to find any evidence supporting the allegation. Although the allegation may have happened or is valid, there is no preponderance of evidence to prove the above allegation did or did not occur, therefore the allegation is unsubstantiated. No deficiencies were observed or cited during today’s visit. LPA conducted an exit interview with Executive Director, Kenia Padilla, and a copy of this report was emailed due to technical issues with LPA's printer.the state’s words, verbatim · CDSS document, Mar 11, 2024 · control 11-AS-20230802134530

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.

Licensing Program Analyst (LPA) Ernand Dabuet made an unannounced visit to the facility and was greeted by Wellness Director (S4: Fabiola Mariano). LPA conducted a risk assessment prior to entering the facility. S4 informed LPA that the facility has no COVID cases nor do the residents or staff have symptoms. The purpose for today’s visit is to conduct a subsequent visit and deliver the findings pertaining to the above-mentioned allegations. The investigation consisted of the following: An initial 10-Day visit was conducted by LPA Susan Campos on 07/07/21 who met with Administrator Mariano. During the visit, LPA requested copies of files for R1-R5 Physician’s Reports (dated 07/09/21), Admission Agreement (dated 06/25/20), Emergency and Identification Information (dated 06/25/20), Appraisal/Needs & Services Plan (dated 07/12/21), Fall-Risk Plan (dated 06/25/20), Resident (Evaluation Report continues LIC 9099-C) Substantiated Assessment (dated 06/25/20), Hospice Care Plan (effective 07/08/21), Hospice Notes (dated 07/09/21), Medication Administration Records (June 2021 thru July 6, 2021), Administrator's Certificate, Facility Sketch, Facility Sign-in/Sign-out sheets (June 2021 thru July 6, 2021), Daily Routine Schedule (June 2021 thru July 6, 2021), House Rules, Facility Staff In-service Training (dated 04/30/21, 07/08/21, 07/09/21, 07/12/21, 07/13/21, 07/14/21, 07/15/21, 07/28/21), Incident Reports (dated 01/19/21, 01/29/21, 03/13/21, 05/31/21, 06/09/21, 06/19/21, 06/27/21), facility staff work schedules (June 25, 2021 thru June 30, 2021), facility staff and residents’ rosters. This complaint investigation was referred to California Department of Social Services (CDSS), Investigation Bureau (IB) and assigned to Investigator Robert Kujawa. The investigation included interviews with medical services staff (Witness #1), family members (RP/POA), facility staff (A1, S1 – S5), and residents (R1 – R5) and a review of medical records (dated 07/01/21 – 07/08/21) from St. Mary Medical Center Long Beach. INVESTIGATION REVEALED THE FOLLOWING: Regarding Allegation #1: Resident #1 sustained multiple falls at the facility based on a review of facility incident reports (dated 01/19/21, 01/29/21, 03/13/21, 05/31/21, 06/09/21, 06/19/21, 06/27/21). Resident #1’s last known fall was on 06/27/21, the resident sustained an injury for which the resident did not receive medical treatment until four (4) days later 07/01/21. Facility staff notified the resident’s physician and family members about the fall; and Resident #1 showed no signs of injury or complaint of pain and discomfort at the time of the fall on 06/27/21. Resident #1 began complaining of pain in their right arm on 07/01/21; and facility staff notified the resident’s physician who examined Resident #1 who requested that the resident be transported to the hospital’s ER. Resident #1 was transported and admitted to St. Mary’s Hospital on 07/01/21. Upon discharge from the hospital on 07/08/21, Resident #1 returned to the facility with a sling on their right arm after undergoing treatment. Interviews conducted of medical services staff and a review of hospital medical records (dated 07/01/21 – 07/08/21) documented Resident #1 sustained a closed fracture of neck of right proximal humerus diagnosis during their last known fall on 06/27/21. Interviews conducted of facility staff corroborated that Resident #1 had sustained multiple falls and received the proper care from facility staff following each fall. Facility staff took steps according to the resident’s fall-risk plan to try and prevent further falls by vocalizing resident to ask for assistance. (Evaluation Report continues LIC 9099-C) Based on the evidence gathered and interviews conducted, and records reviewed, the preponderance of evidence standard has been met; therefore, the allegation of NEGLECT/LACK OF SUPERVISION: Neglect/lack of care and supervision resulted in the resident falling multiple times and sustaining an injury while in care is found to be SUBSTANTIATED. According to the California Code of Regulations (Title 22, Division 6, Chapter 8), the following deficiency has been observed and citation(s) issued (ref. LIC 9099D). Civil penalty assessed. Regarding Allegation #2: this investigation revealed that facility staff did not seek medical care to Resident #1 until four (4) days after the resident’s last known fall on 06/27/21 because the resident complained of pain to the right arm on 07/01/21. Resident #1 was transported to St. Mary’s Hospital Emergency Room (ER) for further evaluation and was admitted to the hospital with a diagnosis of right proximal humeral meris fracture. Resident #1 was evaluated by an orthopedic specialist recommending non-surgical intervention, as it would heal itself. Interviews conducted of facility staff corroborated that after each unforeseen fall, Resident #1 was evaluated for pain by facility staff - along with notifications made to the resident’s physician and family members based on documented incident reports (dated 01/19/21, 01/29/21, 03/13/21, 05/31/21, 06/09/21, 06/19/21, and 06/27/21). A review of the resident’s medical records documented that Resident #1 had a history of falls and was at a high-risk for falls. Resident #1’s physician recommended to facility staff: a plan of action - which facility staff updated and implemented on the resident’s appraisal/needs and services plan and fall-risk plan. Based on the evidence gathered and interviews conducted, and records reviewed, the preponderance of evidence standard has been met; therefore, the allegation of NEGLECT/LACK OF SUPERVISION: Staff did not seek timely medical treatment for resident is found to be SUBSTANTIATED. According to the California Code of Regulations (Title 22, Division 6, Chapter 8), the following deficiency has been observed and citation(s) issued (ref. LIC 9099D). An exit interview has been conducted and a copy of the Complaint Report and Appeal Rights were provided to the Wellness Director (Fabiola Marciano). ECP: 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.”the state’s words, verbatim · CDSS document, Mar 2, 2024 · control 11-AS-20210706084504

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(a)(2) · Plan of correction due date: Mar 3, 2024

Incidental Medical and Dental Care. (a) A plan for Incidental, medical and dental care shall be developed by each facility. The plan shall encourage routine medical and dental care and provide for assistance in obtaining such care... (2) The licensee shall provide assistance in meeting necessary medical and dental needs... This requirement is not met as evidenced by: Resident #1’s last known fall on 06/27/21; whereby, the resident sustained a closed fracture of neck of right proximal humerus injury for which the resident did not receive medical treatment until four (4) days later on 07/01/21. This violation posed an immediate health and safety to residents in care.the state’s words, verbatim · CDSS document, Mar 2, 2024

Plan of correction: Licensee/Administrator shall read Title 22, Section “Incidental Medical and Dental Care" and send a written statement to CCLD no later than the POC date. The plan is due to the CCLD/El Segundo ASC Office by (03/03/24) fax at 424-544-1016 Attn: Elizabeth Ceniceros. Immediate Civil Penalty $500.00

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87705(c)(A) · Plan of correction due date: Mar 3, 2024

Care of Persons with Dementia (c) Licensees who accept and retain residents with dementia shall be responsible for ensuring the following: (A) Dementia care including, but not limited to behavioral challenges...assisting with activities of daily living...skin care, communication... This requirement is not met as evidenced by: Resident #1 had a history of falls based on the physician’s report. (R1's) PCP recommended to facility staff that a plan of action needs to be implemented for the resident due to being a high risk for falls. This violation posed an immediate health and safety to residents in care. NOTE: facility updated Fall-Risk Assessment (dated 07/08/21).the state’s words, verbatim · CDSS document, Mar 2, 2024

Plan of correction: Licensee/Administrator shall read Title 22, Section "Care of Persons with Dementia” and send a written statement to CCLD no later than the POC due date. The plan is due to the CCLD/El Segundo ASC Office by (03/03/24) fax at 424-544-1016 Attn: Elizabeth Ceniceros.

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.

THIS REPORT SUPERSEDES THE REPORT DATED 02/13/2023 FOR CLARIFY THE CIRCUMSTANCE FOR THE ALLEGATIONS. ALTHOUGH THIS REPORT SUPERSEDES THE PREVIOUS REPORT THE COMPLAINT INVESTIGATION FINDINGS HAVE CHANGED: SUBSTANTIATED On 02/13/2023 around 09:00 AM Licensing Program Analyst (LPA) Jose Calderon initiated a complaint investigation for Regency Palms Long Beach facility to deliver the investigation findings for the allegation listed above. Today’s complaint investigation was conducted face to face with Administrator Kenia Padilla (A1). Investigation consisted of: LPA Calderon interviewed Administrator Kenia Padilla A1, S1-S8 and R1-R6. These interviews were conducted on 02/13/2023 and 07/27/2023. On 02/13/2023 and 07/27/2023 LPA Calderon obtained and reviewed in service training: Call log notes (dated March, April, May 2023), incontinence care training (dated 05/27/2023), Toileting log training (dated 1/18/23, 5/27/23), Staff Rounds endorsement training (dated 5/11/23, 5/23/23), Caregiver duties training (dated 5/17/23). Body checks and shower training (dated 5/4/23), Transfer/2-person assistance training (dated 2/18/23), Checking bathrooms and resident rooms at end of shift training (dated 2/9/23), Medical records training (dated 2/7/23) for residents in care. The investigation revealed the following: Substantiated Regarding Allegation #1: Facility personnel are always not sufficient in numbers to prevent residents from falling. This complaint alleged that facility personnel are not sufficient to prevent residents from falling. LPA Calderon conducted an interview with A1. A1 expressed that the facility is not understaffed, and residents do not fall due to lack of staffing. A1 said that the facility has floaters that work on each floor as needed. A1 expressed that staff need to do is call for assistance and a nurse, LVN or floater will be there to help with residents’ needs. LPA Calderon conducted an interview with S1-S8. 8 out of 8 staff expressed that the facility is understaffed, and residents fall due to health condition and staffing issues. 8 out of 8 staff state that the resident to staff ratio on average is 8 to 1 per floor. 8 out of 8 staff said that there are higher ratios on different floors and that there are 2 staff floaters that help with the care of residents. 8 out of 8 staff state that there are 2 staff med-tects in the facility to support the care staff with the needs of residents but for the most part there is only 1 staff member on any floor and falls do happen. LPA Calderon attempted to interview R1-R6. 6 out of 6 residents were unable to communicate due to impairments. Regarding Allegation #2: Facility personnel are always not sufficient in numbers to answer resident call button in a timely manner. This complaint alleged that there is not enough staff to answer residents call button. LPA Calderon conducted an interview with A1. A1 expressed that the day shift and night shift are different because most residents are sleeping on the night shift and there are less residents that push the call button. A1 expressed that there is an 8 to 1 ratio and 2 floaters and 2 med-tecks that work each day and night shift and any time a call button is pushed staff answers. A1 expressed that there are no staffing issues and there are enough staff to answer call buttons within 3 to 7 minutes. LPA Calderon conducted an interview with S1-S8. 8 out of 8 staff said that most of the time the call button is not pushed at night as residents are sleeping. 8 out of 8 staff expressed that on average the call button is pushed more often in the daytime as most residents are out of bed. 8 out of 8 staff state that there are not enough staff to answer the resident call button and on average it takes 5 to 10 minutes depending on the resident situation. LPA Calderon attempted to interview R1-R6. 6 out of 6 residents were unable to communicate due to impairments. Regarding Allegation 3: Facility personnel are always not sufficient in numbers to meet resident needs for incontinence care. This complaint alleged that there are not enough staff to meet incontinence care. LPA Calderon conducted an interview with A1. A1 expressed that not all residents in care need incontinence services. A1 expressed that most residents diaper can be changed by one staff member. A1 expressed that there are 2 staff floaters and 2 staff med-tects that work every shift. A1 expressed that if staff needs help with residents’ incontinence care staff can make a call for assistance. A1 expressed that there is no staffing issue at the facility and there are enough staff to take care of the residents with incontinence care. LPA Calderon conducted an interview with S1-S8. 8 out of 8 staff said that there are staffing issues in the facility. 8 out of 8 staff said that not all residents in the care need incontinence services. 8 out of 8 staff expressed that due to staffing issues it takes longer to care for residents with incontinence needs. LPA Calderon attempted to interview R1-R6. 6 out of 6 residents were unable to communicate due to impairments. On 07/07/2023 LPA Calderon reviewed staff training records for incontinence care (dated 5/27/2023) and log notes for March and April and May 2023 which support staff providing incontinence care to resident. Regarding Allegation #4: Facility personnel are always not sufficient in numbers to meet resident needs for showering. This complaint alleged that there are not enough staff to meet resident showering needs. LPA Calderon conducted an interview with A1. A1 expressed that staffing needs are different from the day shift to night shift and are different care needs per floor. A1 expressed that there are 2 staff floaters and 2 staff med-tects that work each shift. A1 expressed that not all residents are given a shower at the same time or on the same day and that there is always another staff member to support the floor caregiver when needed. A1 expressed that no resident goes without a shower. LPA Calderon conducted an interview with S1-S8. 8 out of 8 staff said that the staff to resident ratio changes per floor. 8 out of 8 staff expressed that giving a shower or bath to a resident is a 2-person job and most times there is only 1 staff member to give a resident a shower. 8 out of 8 staff said there are staffing issues and not enough staff to clean all residents timely. LPA Calderon attempted to interview R1-R6. 6 out of 6 residents were unable to communicate due to impairments. On 07/27/2023 LPA Calderon reviewed staff training records for showering residents (dated 05/04/2023). LPA Calderon reviewed log notes for March and April 2022 for staff giving showers to residents. Reviewed caregivers’ duty (dated 5/17/2023), and staff rounds training (dated 05/11/2023). LPA Calderon noted staff trained on how to shower resident, but limited staff have the training. Although the allegation may have happened or is valid, there is a preponderance of evidence to prove the alleged violation(s) did occur, therefore the allegation “facility personal 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 button 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” is substantiated. California Code of Regulations, Title 22, Division 6 are cited on the attached LIC 9099D. An exit interview was conducted, and a copy of the Complaint Report and Appeal Rights were provided to the Administrator Kenia Padilla (A1).the state’s words, verbatim · CDSS document, Jan 18, 2024 · control 11-AS-20230206134252

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87411(a) · Plan of correction due date: Jan 31, 2024

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....This requirement is not met as evidenced by: Based on interviews, and record review, the licensee failed to ensure adequate staffing to meet resident’s needs which posed a potential health risk to residents in care.the state’s words, verbatim · CDSS document, Jan 18, 2024

Plan of correction: Administrator will hire enough staff to meet resident to staff ratio and ensure enough staff to meet residents needs.

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

THIS REPORT SUPERSEDES THE REPORT DATED 08/31/2023 FOR CLARIFYING THE CIRCUMSTANCE FOR THE ALLEGATIONS. ALTHOUGH THIS REPORT SUPERSEDES THE PREVIOUS REPORT THE COMPLAINT INVESTIGATION FINDINGS REMAIN THE SAME: UNSUBSTANTIATED Licensing Program Analyst (LPA) Jose Calderon conducted an unannounced visit to Regency Palms Long Beach Facility on 08/31/2023 and was greeted by Administrator Kenia Padilla (A1). LPA Calderon explained the purpose of this visit is to deliver the findings pertaining to the above-mentioned allegations. The investigation consisted of the following: LPA Calderon interviewed Administrator (A1), staff (S1-S4), residents (R1-R5), witness (W1-W2). On 08/31/2023 LPA Calderon requested and reviewed copies of the following: Physician Report (dated 02/01/2023), Needs and Services Plan (date 05/10/2023), In service colostomy training (date 04/16/2023), In service showering training (date 02/09/2023), Excel home care provider communication (date 02/01/2023 to 08/28/2023), Service plan (date 05/10/2023) for R1. The investigation revealed the following: Unsubstantiated Regarding Allegation #1: Staff neglect properly cleaning resident when providing incontinent care. It is being alleged that staff neglected to properly clean R1 when providing incontinent care. LPA Calderon toured the facility with A1. During tour of the facility LPA noted staff going into resident rooms to provide incontinent care. Records reviewed indicate the following: LPA reviewed in service training conducted on 02/09/2023 regarding cleaning/showering for R1. In service training indicates staff provided showers 3 times per week or when needed and cleaning directions. The facility service plan (date 05/10/2023) for R1 indicates that staff are to give assistance with bathing to R1 3 times per week. Interviews with staff indicate the following: The Excel home health care provided incontinent training to staff regarding colostomy bag leaks. the fecal matter. Staff provides showers to R1 3 times per week or when needed and R1 refuses to take more than 1 shower per week. Interviews indicated the following: 4 out of 4 staff indicate there was training provided by Excel home healthcare staff on leaking colostomy bags, residents are provided with 3 showers per week or when needed, that R1 refuses to take more than 1 shower per week, and that R1 colostomy bag does leak and R1 touches R1 fecal matter and staff cleans R1 when this happens. 2 out of 2 witnesses indicated the following: that training was provided to facility staff for colostomy bag leaks and cleaning training for fecal matter, and that home health care is aware of R1 colostomy bag leaks due to age and overall health conditions. R1 indicated that R1 has 3 fistulas on R1 left side of the stomach, the colostomy bag does leak, home health care and facility staff are aware of the leaking bag, that there is fecal matter on R1 stomach area, but not all over R1 body, staff does offer R1 3 showers per week or when needed, but R1 refuses to take more than 1 shower per week, and R1 admits that R1 should take more than 1 shower per week but does not. R1 indicates that R1 is happy with the services provided by the staff. 5 out of 5 residents denied the allegation for colostomy bags and staff do provide 3 showers per week to residents. Regarding Allegation #2: Staff are not following medical orders.It is being alleged that staff are not following wound care orders. During the investigation, LPA observed that 2 caregivers reposition per doctor’s orders as indicated in R1’s wound care. Records reviewed indicate: Needs and services plan dated 05/10/2023 indicates that staff are to provide 3 showers per week and staff will assist in colostomy care. Records reviewed indicate the following: Physician report dated 02/01/2023 indicates that colostomy bag is needed for R1. Service plan dated 05/10/2023 indicates that staff are to aid R1 for bathing or showering 3 times per week. Excel Home Health Care in-service training for dated 02/09/2023, indicates that staff are to provide shower 3 times per week and to make sure to check that R1 is clean and taking showers and that staff are to assist in R1’s colostomy care. In-service training dated 04/16/2023 indicates that Staff are to change R1 colostomy bag every two days or if there is leaking outside of the colostomy bag. Interview conducted indicate the following: Excel Home Health Care staff did provide training to facility staff on colostomy bags leaks, fecal leaks, and open wounds and how to attach the bag to R1 body. Excel Home Health Care provided additional training to staff on how to shower R1 by A1. A1 indicated that staff did follow doctors’ orders for colostomy bag and cleaning of fecal matter from R1. 4 out of 4 staff indicated that formal training was provided by home health care staff regarding colostomy bag and fecal matter cleaning for R1. 4 out of 4 staff indicate they did receive in-service training in colostomy bag services and showering for R1. 4 out of 4 staff state they follow medical orders for R1 care. 2 out of 2 witnesses stated that that facility staff were provided training on how to change a leaking colostomy bag and how to clean R1 fecal matter per doctor’s order. 2 out of 2 witnesses indicate the last call to home health care for R1 leaking colostomy bag was on 08/28/2023 and training was provided to facility staff per doctor’s orders. 4 out of 5 residents indicate that the home health care staff provided training to facility staff regarding R1 leaking colostomy bag and cleaning fecal matter per doctor order. R1 indicates that facility staff do follow doctors’ orders and R1 is happy with the services provided by staff. 4 out of 5 resident indicates that they have no need for colostomy bags and residents indicates that they have seen facility staff training. 4 out of 5 residents indicate that they are happy with staff services and resident indicate that staff do follow doctors’ orders. Based on interviews, observations, and supporting documentation, the preponderance of evidence standard has not been met; therefore, the allegations of “staff neglect properly cleaning resident when providing incontinent care”, “staff are not following medical orders” 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 Kenia Padilla A1.the state’s words, verbatim · CDSS document, Jan 4, 2024 · control 11-AS-20230828084200

Type of visit: Required - 1 Year

On 10/27/2023 at 09:00 AM, Licensing Program Analyst (LPA) Jose Calderon conducted an unannounced annual inspection visit at Facility Regency Palms Long Beach. LPA Calderon was allowed entry into the facility by Administrator Kenia Padilla. The facility is licensed for 91 residents aged 59 and over. Currently, there are 61 residents residing in the facility. LPA Calderon explained to Administrator Kenia Padilla, the purpose of the 1-year Annual Inspection visit, and Administrator Kenia Padilla escorted LPA Calderon on a tour of the entire inside and outside facility grounds. As part of the inspection, LPA Calderon reviewed: Six resident service records, Six resident medication records. LPA Calderon interviewed six residents and six staff members for visit. LPA Calderon inspected the inside facility and outside grounds. The facilities’ last fire drill was conducted on 07/18/2023. The eight story commercial building has a memory care unit (floors 2,3,4,5,6) and assisted living community (floors 7,8) consisting of (56) resident bedrooms, (56) resident bathrooms, twelve common bathrooms, dining rooms, commercial kitchen, staff area, office area, commercial washer and dryer room/ storage area, Movie room, activity room, roof patio with umbrella, tables, and chairs. No weapons are stored on the premises. Commercial Kitchen was inspected and observed to be clean and operational. A 2-day supply perishable and 7-day supply of non-perishable foods are present in the facility kitchen. Seven day emergency water supply located in the kitchen and storage room. During the visit, LPA Calderon observed the facility infection control practices. LPA Calderon observed screening protocols for visitors, staff, and residents, sanitizing stations (Located in common areas and restrooms). LPA Calderon observed staff and residents were wearing face coverings throughout the facility. LPA Calderon observed the facility has a 30-day supply of Personal Protective Equipment (PPE). LPA Calderon advised the Administrator Kenia Padilla to continuously monitor the Centers for Disease Control (CDC) website and Community Care Licensing Provider Informational Notices (PIN) for any updates relating to COVID-19 guidance. . According to the California Code of Regulations (Title 22, Division 6, Chapter 8), LPA Calderon did not observe any deficiencies therefore no citations were issued at this time. An exit interview was conducted, and a copy of the Facility Evaluation Report was provided to Administrator Kenia Padilla. LPA Calderon observed that all facility rooms are clean and in good repair. A comfortable temperature of 73.0 degrees was maintained by central air and heating. LPA Calderon observed the following during inspection of resident rooms #402, #408, #608, #706, #804, #807. LPA Calderon noted that resident mattresses are in good condition, there is adequate lighting present, plenty of dresser/closet space is present, and all bed linens present. All bedrooms contain furniture, lighting fixtures and personal storage space as required, all beds have the required amount of linen and mattress covers, LPA Calderon observed fully stocked storage room with bedding, towels, and toiletries supplies. Bathroom fixtures are clean, in good repair, and working properly and contain the required nonskid mats and grab bars. LPA Calderon observed bathrooms were found to be within Title 22 regulation. Bathroom #1 hot water temperature properly measured at 113 degrees Fahrenheit, and bathroom #2 hot water temperature properly measured at 110 degrees Fahrenheit. Bathroom #3 hot water temperature properly measured at 113 degrees Fahrenheit. Bathroom #4 hot water temperature properly measured at 113 degrees Fahrenheit. Commercial Kitchen hot water temperature properly measured at 120 degrees Fahrenheit. The facility (10) Carbon Monoxide and (107) Smoke Detectors are hard wired and connected to each other. Smoke detectors were tested and are working properly. The facility has (39) Fire Extinguishers that were checked and found to be fully charged and accessible to staff and residents. All exit doors in the facility have alarm systems and security pads to unlock doors. All toxins and knifes are locked/secured and inaccessible to residents. Residents’ medications are centrally stored in the locked medication room and in a locked storage cabinet while on facility grounds. Facility has ten first aid kits which are fully stocked with manuals was checked and in order. All Exits/ Walkways around the facility were free of debris and hazards. Roof patio accessible to all residents. Six resident medications reports were checked, and they were all found to be administered according to doctor's orders. Six staff files were checked and have the required documents. The facility does NOT handle resident's money/cash resources. LPA Calderon noted the Administrator Kenia Padilla Certification # 6048819740 expiration date of 06/28/2024 was valid at time of visit. Commercial General Liability Policy #SHS0000780 policy period from 05/01/2023 to 05/01/2024 underwritten by Scottsdale Insurance Company, coverage 1,000,000/3,000,000 is valid at time of inspection. LPA Calderon spoke to Administrator Kenia Padilla who will email full copy of insurance contract which shows all coverages to LPA Calderon no later than 11/14/2023. All the required documents are posted in the facility in a clearly visible area to all staff, residents, and guests. LPA Calderon reviewed LIC500 and noted all staff associated to facility per LIS. LPA Calderon reviewed the resident roster, LPA Calderon confirmed residents’ interview are on resident roster.the state’s words, verbatim · CDSS document, Oct 27, 2023