Regency Palms Long Beach

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

Allegation investigated: Staff did not provide meals to a resident in care.

On 09/25/23 Licensing Program Analyst (LPA) Mario Leon conducted an unanounced visit to the above facility to investigate the above allegation. LPA was met by Kenia Padilla, Executive Director (S1), and the purpose of the visit was explained. The investigation consisted of the following: On 09/25/23 LPA Leon toured the facility with S1, interviewed five (5) residents (R1-R5) and three (3) staff (S1-S3) and interviewed one (1) witness. LPA Leon requested and reviewed facility documents. The Investigation revealed the following: Regarding the allegation: Staff did not provide meals to a resident in care. It has been alleged that the facility is out of food. On 09/25/23 LPA observed the industrial kitchen, which contained ample food supply in the pantry, walk-in refrigerator and walk-in freezer. Report continues, see LIC9099C. Unsubstantiated LPA interviewed 5 out of fifty-three (53) residents and observed 5 boxed breakfasts, each box marked appropriately for the resident's room. All 5 residents have denied the allegation. LPA interviewed 3 staff and 1 witness. 3 out of four (4) interviewees have denied the allegation. According to LPA's observations, interviews and record review conducted, there is not enough evidence to support the above allegation. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove that the alleged violation occurred, therefore the above allegation is Unsubstatiated.the state’s words, verbatim · CDSS document, Sep 25, 2023 · control 11-AS-20230920124459

Allegation investigated: Resident sustained a fractured hip while in care. Resident sustained multiple falls while in care. Facility staff improperly restrained resident. Facility staff did not safeguard resident's personal belongings. Facility staff did not allow resident to leave the facility with family. Facility staff are not properly assisting resident with transfers. Facility resident threatens visitor. Facility staff not assisting resident with ADLs.

Licensing Program Analyst (LPA) Ernand Dabuet made an unannounced visit to the facility and was greeted by Care Coordinator (S3: Fabiloa Marciano). LPA spoke to (S3) prior to entering the facility to conduct a risk assessment. (S3) informed LPA that the facility has no COVID cases nor do any of 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. An initial 10-Day visit was conducted by LPA Susan Campos on 09/03/21 with Administrator Mariano. During the visit with Administrator, LPA conducted a tour of the facility’s physical plant and food inspection for health and safety purposes. LPA also requested copies of R1-R5 Physician Reports, R1-R5 Admission Agreements, R1-R5 Incident Reports (from 01/20-Present), R1-R5 Hospice Notes, R1-R5 Home Health Notes, R1-R5 Case Notes, R1-R5 Medication Administration Records, R1-R5 Emergency and Identification Information, R1-R5 Fall Plan, R1-R5 Needs Assessment Plan, LIC 500, Staff Work Schedules, Residents’ Roster, and Administrator's Certificate. (Evaluation Report Continues LIC 9099-C) Unsubstantiated Obtained actual staff work schedules (months of July 2021 and August 2021), Facility Sketch, Facility Sign-In/Sign-Out sheets (month of August 2021), Daily routine schedule, and House Rules. A separate investigation was conducted by the Department of Social Service Investigator (Douglas Real) which included a review of medical records and interviews with facility staff and medical services staff. INVESTIGATION REVEALED THE FOLLOWING: Regarding Allegation #1: this investigation alleges that Resident #1 sustained a fractured right hip while in care at the facility. Prior to moving into the facility on 08/17/19, Resident #1 fell at their home and sustained a broken left hip. Reporting Party told I.B. Investigator Douglas Real on 09/03/21 that they claimed to have evidence to support neglect by the facility; but Reporting Party was unable to provide evidence by the close of this investigation on 01/27/22. Hospital records obtained had indicated that Resident #1 was admitted to the hospital on 08/27/21 and had sustained a sub-capital fracture of the right hip after a fall from the resident’s wheelchair in their bedroom. Surgery was performed and Resident #1 was discharged from the hospital on 09/05/21 to a skilled-nursing facility (SNF) for rehabilitation, per a courtesy call from the resident’s Conservator. No abuse or neglect concerns were noted in the hospital records nor law enforcement or DA involvement. Resident #1 could not recall falling in the facility because of the resident’s cognitive diagnosis. Resident #1 was listed as not being able to independently transfer to/from bed (non-ambulatory). Facility employees reported monitoring Resident #1 more frequently due to their fall-risk behavior. Residents interviewed corroborated that facility staff are helpful and respond quickly when asked to help and provide an appropriate level of care and supervision. Residents interviewed have not observed facility staff harm or neglect residents in care. Resident #1’s Conservator and responsible person were very pleased with the level of care and supervision that Resident #1 was receiving at the facility. Based on the evidence gathered and interviews conducted and records reviewed, 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 of NEGLECT/LACK OF SUPERVISION: Resident sustained a fractured hip while in care is found to be UNSUBSTANTIATED. Evaluation Report continues LIC9099-C Regarding Allegation #2: this investigation alleges that Resident #1 sustained multiple falls while in care at the facility. Resident #1 is wheelchair bound and could not ambulate on their own; therefore, the resident had an ongoing behavior of attempting to get out of bed or the wheelchair. Resident #1 did not have a one-on-one supervision, nor did they have a private caregiver attending to the resident 24/7. The facility mitigated Resident #1’s fall-risk behavior by checking on the resident more frequently and utilizing a bed alarm mat that notified facility staff whenever the resident got out of bed that was placed on the floor next Resident #1’s bed. The increased supervision by facility staff provided an appropriate level of supervision – despite the behavior demonstrated by the resident. Resident #1’s Conservator and Responsible Person were very pleased with the level of care and supervision that Resident #1 was receiving at the facility. Based on the evidence gathered and interviews conducted and records reviewed, 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 of NEGLECT/LACK OF SUPERVISION: Resident sustained multiple falls while in care is found to be UNSUBSTANTIATED. Regarding Allegation #3: this investigation alleges that Resident #1 was being improperly restrained from getting out of their wheelchair by facility staff. Resident #1 is wheelchair bound and could not ambulate on their own and had an ongoing behavior of attempting to get out of bed or the wheelchair. The increased supervision (by facility staff) provided an appropriate level of supervision – despite the behavior demonstrated by Resident #1. Interviews conducted with facility staff (A1, S1-S4) and residents (R2-R9) corroborated that a resident was not observed restrained improperly in a wheelchair. A review of Resident #1’s “Physician Report” (dated 10/16/20) and “Appraisal/Needs and Services Plan” (dated 03/03/21) and “Requirements for Private Duty Attendants Providing Services at the Community” were on file. A review of Resident #1’s records did not document that the resident had an “Exception Waiver” for postural support (restraint/belt) on file. Administrator Mariano is aware that if one is needed for a resident, Administrator will notify Community Care Licensing (CCL) and have a doctor's order on file for the resident prescribing the support (pursuant to Section 87608 Postural Supports). Interviews conducted of facility staff (A1, S1-S4) corroborated that the staff are very attentive to the residents’ needs and provide a good level of care for these residents. Interviews conducted of witnesses (W1 & W2) were very pleased with the level of care and supervision that Resident #1 was receiving at the facility. Evaluation Report continues LIC9099-C An interview was not conducted with Resident #1 due to the resident’s cognitive impairment. Interviews conducted of residents (R2-R9) corroborated that they are very happy living at the facility and that facility staff are meeting their needs. Based on the evidence gathered and interviews conducted and records reviewed, 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 of PERSONAL RIGHTS: Facility staff improperly restrained resident is found to be UNSUBSTANTIATED. Regarding Allegation #4: this investigation alleges that facility did not safeguard Resident #1’s clothes; and, another resident was observed wearing Resident #1’s clothing during Reporting Party’s visit to the facility. In addition, Resident #1 was wearing a different pair of prescription eyeglasses that did not belong to them. On or about 08/10/21, Resident #1 developed a behavior of removing their clothing from their person as witnessed by a hospice provider visit; and, it was reported to the resident’s Primary Care Physician and Conservator. Interviews conducted of facility staff corroborated that the staff do safeguard residents personal belongings and were unaware of a resident missing personal belongings. An interview was not conducted with Resident #1 due to the resident’s cognitive impairment. Residents (R2-R9) were interviewed and did not express concerns with facility staff not safeguarding their personal belongings. Administrator Mariano stated that facility staff would follow protocol if a resident reported missing personal belongings from their room. A review of Resident #1’s “Safeguard for Property/Valuables” was on file. Resident #1’s Conservator and Responsible Person were very pleased with the level of care and supervision that Resident #1 was receiving at the facility. Based on the evidence gathered and interviews conducted and records reviewed, 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 of PERSONAL RIGHTS: Facility staff did not safeguard resident's personal belongings is found to be UNSUBSTANTIATED. Evaluation Report continues LIC9099-C Regarding Allegation #5: this investigation alleges that a family member (daughter) wanted to take Resident #1 for a short trip and was prevented from taking the resident out of the facility. Resident #1 is under a Conservatorship; therefore, instructions were given to the facility. A review of L.A. County Superior Court documents (dated 06/24/21) states that Resident #1 is under a Conservatorship. A review of Resident #1’s “Identification and Emergency Information” (dated 08/17/19) does not list the family member (daughter) as a responsible person or other person to be notified in emergency. A review of Resident #1’s “Appraisal/Needs and Services Plan” (dated 03/03/21) documents that the family member (daughter) is not allowed to take Resident #1 outside of the community. A review of Resident #1’s “Personal Rights” form (dated 08/17/19) was on file. Based on the evidence gathered and interviews conducted and records reviewed, 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 of PERSONAL RIGHTS: Facility staff did not allow resident to leave the facility with family is found to be UNSUBSTANTIATED. Regarding Allegation #6: this investigation alleges that a family member (daughter) visiting with Resident #1 observed a caregiver improperly lifting and placing the resident to use the restroom. Interviews revealed that facility staff have received hands on and classroom training, Staff 1-3 (S1-S3) interviewed stated staff are trained and are receiving ongoing training. A review of facility staff training records documents the topic “Proper Body Mechanics” including “hands-on” Transfer Training conducted by a home health physical therapist. Interviews conducted of facility staff (A1, S1-S4) corroborated that they are trained to transfer residents and receive ongoing training. Interviews conducted of witnesses (W1 & W2) corroborated that they have observed facility staff to be competent, trained, and providing the necessary care and supervision to meet the needs of Resident #1. An interview was not conducted with Resident #1 due to the resident’s cognitive impairment. Interviews conducted of residents (R2-R9) corroborated that facility staff are trained to assist residents with their daily needs and provide the care and supervision. Based on the evidence gathered and interviews conducted and records reviewed, 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 of PERSONAL RIGHTS: Facility staff are not properly assisting resident with transfers is found to be UNSUBSTANTIATED. Evaluation Report continues LIC9099-C Based on the evidence gathered and interviews conducted and records reviewed, 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 of NEGLECT/LACK OF SUPERVISION: Facility staff not assisting resident with ADLs is found to be UNSUBSTANTIATED. An exit interview has been conducted and a copy of the Complaint Report was provided to Care Coordinator Fabiola Marciano. Regarding Allegation #7: this investigation alleges that Resident #2 walked into Resident #1’s room (holding a plastic knife in one hand and private part in the other hand) while family member (daughter) was changing Resident #1. Interviews conducted of facility staff (A1, S1-S4) corroborated that the residents in the memory care unit do not threaten other residents; and, they get along. Administrator Mariano had not received a complaint from facility staff or residents or their responsible person/conservator that a resident threatened another resident or visitor at the facility. Interviews conducted of facility staff (S1-S4) corroborated that they have not witnessed Resident #2 or any of the other residents threaten Resident #1 or their visitor. Interviews conducted of witnesses (W1 & W2) corroborated that they were unaware of an incident involving Resident #2 threatening Resident #1’s or their family member (daughter). An interview was not conducted with Resident #1 due to the resident’s cognitive impairment. Interviews conducted of residents (R2-R9) corroborated that that they have never been threatened by another resident; and, they all get along with the other residents in the facility. Based on the evidence gathered and interviews conducted and records reviewed, 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 of NEGLECT/LACK OF SUPERVISION: Facility resident threatens visitor is found to be UNSUBSTANTIATED. Regarding Allegation #8: this investigation alleges that facility staff are not regularly brushing Resident #1’s teeth and not assisting the resident with changing their clothing regularly. A review of Resident #1’s “Appraisal/Needs and Services Plan” (dated 03/03/21) documents that facility staff assists the resident with all toileting needs and bathing needs. A review of Resident #1’s “Physician Report” (dated 10/16/20) documents that facility staff assist the resident with dressing/grooming. Interviews conducted of facility staff (A1, S1-S4) corroborated that the staff are very attentive to Resident #1s’ needs and provide a good level of care. Interviews conducted of witnesses (W1 & W2) corroborated that they were very pleased with the level of care and supervision that Resident #1 was receiving at the facility. An interview was not conducted with Resident #1 due to the resident’s cognitive impairment. Interviews conducted of residents (R2-R9) corroborated that they are very happy living at the facility and that facility staff are attentive in providing the care and supervision to meet their activity of daily living needs. Evaluation Report continues LIC9099-Cthe state’s words, verbatim · CDSS document, Mar 11, 2023 · control 11-AS-20210902085404

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.

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 Director S1. The Investigation consisted of the following: On 02/07/2023 LPA Calderon attempted to interview W1 for complaint. On 02/13/2023 LPA Calderon and Director S1 conducted a tour of the physical plant. On 02/13/2023 LPA Calderon obtained copies of Staff and Resident rosters, LIC500. On 02/13/2023 LPA Calderon interviewed S1-S7 regarding complaint and on 02/13/2023 LPA Calderon attempted to interview R1-R6 for complaint. The investigation revealed the following: Unsubstantiated Allegation 1: Facility personnel are always not sufficient in numbers to prevent residents from falling. On 02/07/2023 LPA Calderon attempted to interview W1 for complaint. Due to W1 being anonymous there was no interview possible. On 02/13/2023 LPA Calderon interviewed S1-S7 who state that the resident to staff ratio is 8 to 1 and that there are 2 staff floaters and 2 staff med-tecks to support the care staff with what is needed, and no resident has fallen due to staffing issues. On 02/13/2023 LPA Calderon attempted to interview R1-R6 due to residents having mental health issues LPA Calderon was not able to ask any questions regarding the allegation. On 02/13/2023 LPA Calderon reviewed the staff roster and LIC 500, which support staffing per day and night shift. Allegation 2: Facility personnel are always not sufficient in numbers to answer resident call button in a timely manner. On 02/07/2023 LPA Calderon attempted to interview W1 for complaint. Due to W1 being anonymous LPA Calderon was not able to ask any questions. On 02/13/2023 LPA Calderon interviewed S1-S7 for complaint. S1-S7 state that the day shift and night shift are different because most residents are sleeping. Staff state that there is a 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. Staff states that most time the button is pushed at night and not daytime as most residents are out of bed. On 02/13/2023 LPA Calderon attempted to interview R1-R6 but due to residents having mental health issues residents could not answer LPA Calderon questions. On 02/13/2023 LPA Calderon reviewed staff roster and LIC500, roster supports day and night staff and supports resident to staff ratio of 8 to 1. Allegation 3: Facility personnel are always not sufficient in numbers to meet resident needs for incontinence care. On 02/07/2023 LPA Calderon attempted to interview W1 for complaint. Due to W1 being anonymous LPA Calderon could not ask a question regarding the allegation. On 02/13/2023 LPA Calderon interviewed S1-S7 for complaint. S1-S7 state that some of the residents need incontinence care. Staff state that most residents diaper can be changed by one person. Staff state that there are 2 staff floaters and 2 staff med-tecks working every shift. staff state that if they need help, they just call, and help is there to help with resident care or other resident care. On 02/13/2023 LPA Calderon attempted to interview R1-R6 for complaint, but due to residents having mental health issues LPA Calderon was not able to ask any question regarding the allegation. On 02/13/2023 LPA Calderon reviewed staff roster and LIC500 which supports staff floaters and 2 med-tecks that work the am and pm shifts. Allegation 4: Facility personnel are always not sufficient in numbers to meet resident needs for showering. On 02/07/2023 LPA Calderon attempted to interview W1 for complaint. Due to W1 being anonymous LPA Calderon could not ask any questions regarding the allegation. On 02/13/2023 LPA Calderon interviewed S1-S7 for complaint. Staff state that there are no issues with residents’ showers. Staff state that staffing needs are different from am to pm shift and there are 2 staff floaters and 2 staff med-tecks that work each shift. Staff state that not all residents are given a shower at the same time and that there is always another staff member to support the floor caregiver when needed. Staff state no resident goes without a shower. On 02/13/2023 LPA Calderon attempted to interview R1-R6 for complaint. Due to residents having mental health issues LPA Calderon was not able to ask questions regarding the allegation. On 02/13/2023 LPA Calderon reviewed staff roster and LIC500. Staff roster supports am and pm staff and floaters and med-tecks working. 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 “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 unsubstantiated. A exit interview was conducted with Director S1, and a hard copy was provided by hand.the state’s words, verbatim · CDSS document, Feb 13, 2023 · control 11-AS-20230206134252

Type of visit: Required - 1 Year

On 12/21/22, at 8:53 am, Licensing Program Analyst (LPA) Mario Leon conducted an unannounced annual required visit with a primary focus on Infection Control measures. LPA was allowed entry into the facility by Carla Mariano, Administrator. LPA met with Ms. Mariano and explained the purpose of the visit. The facility is licensed to operate for ninety-one (91) non-ambulatory with (10) may be bedridden, delayed egress on floors 2-8, with a hospice waiver for 15 residents. The facility is a white, high-rise, 8 story building with a sprinkler system, located in a downtown commercial area. Included in the 8 floor structure is a basement, main floor, memory care community (floors 2,3,4,5,6) and assisted living community (floors 7,8) with a delayed egress at exit points present on floors 2nd – 5th. There are (2) fire extinguishers located on each floor. Water stations are located in the lobby and the dining room (great room) on each of the floors, which showed an average hot water temperature at 107.9 F. The resident room unit has a smoke detector that are battery operated and one hard-wired and interconnected. Each facility floor has a dining room, staff room which includes a locked medication cart and first aid kit and is inaccessible to the residents and also on each floor is an all gender public restroom available for resident use. LPA observed Main floor: Lobby, Reception area, common area and Executive Director office; Basement: Common Area/Activity Room, three (3) Gender Neutral Public Restrooms, wall area with notifications and postings of resident rights, house rules and activities, medication room that is locked and inaccessible to the residents that included magnetic locks on the cabinet, and a medication refrigerator, Laundry room with two commercial washing machines and dryers, supply cabinet with storage of towels, linens, fitted sheets, flat sheets, blankets, mattress pad, mattress covers, storage room contained personal care supplies, Beauty Salon, Activity Room/Art Studio with board games, reading materials and craft supplies, Business Office, Wellness Office, Fitness Room ( PPE supply room is attached), Staff Lounge, Kitchen and food supply room. At the Roof level (9th floor) there is a patio area including string lights, 2 lattice patio covers, 3 umbrellas, and 3 sets of patio tables with chairs. LPA inspected 10 resident rooms and tested the emergency-pull cord in room #507 with the response time at 42 seconds. There were no bodies of water or obstructions on the premises. See LIC 809-C Beds and bedding supplies were in good condition, adequate lighting provided, storage for client personal belongings was observed. Bed linens, comforters, and bath towels were adequately stocked at the time of visit, which are provided by family members and provided by Regency Palms. Bathrooms were found to be within Title 22 regulations and were clean and operational. The hot water temperature was measured for resident rooms and are noted as the following: Room #807 at 118.2 F, Room #507 at 117 F. A comfortable temperature of 73.1 degrees was maintained in the facility. The LPA observed the facility to be sanitary and appropriately furnished at the time of visit. Storage areas for personal hygiene, cleaning supplies, toxins, and sharps were stored and not accessible to clients. The kitchen was inspected and there is sufficient perishable and non-perishable food available and stored properly, with a hot water temperature measured at 139.6 F with notification signs properly posted. All facility (39) fire extinguishers were checked and are charged, last dated 10/22/22, (39) resident room smoke detectors were checked and are operable, and also the facility carbon monoxide detector was checked and is operable. Fire Drills were observed to be maintained in order and accurate, showing the last drill on 12/13/22 . During the visit, LPA observed the facility's infection control practices. LPA observed screening protocols for visitors, staff, and residents, sanitizing stations in common areas and restrooms. LPA observed staff were wearing face coverings, and LPA observed the facility has a 30-day supply of Personal Protective Equipment (PPE). All mandated infection control posters were posted. A review of staff and resident temperature logs were reviewed upon entry. No deficiencies were cited during this inspection visit. An exit interview was conducted and a copy of this report was provided to Administrator Carla Mariano.the state’s words, verbatim · CDSS document, Dec 21, 2022