<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198602567
Report Date: 06/13/2025
Date Signed: 06/13/2025 04:10:37 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/05/2025 and conducted by Evaluator Zina Brown
PUBLIC
COMPLAINT CONTROL NUMBER: 11-AS-20250605110247
FACILITY NAME:REGENCY PALMS LONG BEACHFACILITY NUMBER:
198602567
ADMINISTRATOR:KENIA SANCHEZ PADILLAFACILITY TYPE:
740
ADDRESS:117 E 8TH STREETTELEPHONE:
(562) 432-9260
CITY:LONG BEACHSTATE: CAZIP CODE:
90813
CAPACITY:91CENSUS: 75DATE:
06/13/2025
UNANNOUNCEDTIME BEGAN:
09:53 AM
MET WITH: Fabiola Marciano, Executive DirectorTIME COMPLETED:
04:15 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff did not prevent a resident from sustaining an unexplained injury.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
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
Estimated Days of Completion:
SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Zina Brown
LICENSING EVALUATOR SIGNATURE:

DATE: 06/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 2
Control Number 11-AS-20250605110247
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245
FACILITY NAME: REGENCY PALMS LONG BEACH
FACILITY NUMBER: 198602567
VISIT DATE: 06/13/2025
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
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.

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Zina Brown
LICENSING EVALUATOR SIGNATURE:

DATE: 06/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2