198602567-9-9-2025-11-AS-SCIS-DM4VP6-20251003163615

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198602567
Report Date: 09/09/2025
Date Signed: 09/09/2025 09:03:34 AM

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
08/26/2025 and conducted by Evaluator Bernadette Allen

COMPLAINT CONTROL NUMBER: 11-AS-20250826110419

FACILITY NAME:	REGENCY PALMS LONG BEACH		FACILITY NUMBER:	198602567
ADMINISTRATOR:	ROBERT JAKINI		FACILITY TYPE:	740
ADDRESS:	117 E 8TH STREET		TELEPHONE:	(562) 432-9260
CITY:	LONG BEACH	STATE: CA	ZIP CODE:	90813
CAPACITY:	91	CENSUS: 75	DATE:	09/09/2025
		UNANNOUNCED	TIME BEGAN:	08:30 AM
MET WITH:	Robert Jakini-Administrator		TIME COMPLETED:	09:20 AM

ALLEGATION(S):

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Staff do not ensure that resident is adequately fed.
Staff do not ensure that resident is hydrated.

INVESTIGATION FINDINGS:

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***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

Estimated Days of Completion:

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Bernadette Allen
LICENSING EVALUATOR SIGNATURE:	DATE: 09/09/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/09/2025

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 4

Control Number 11-AS-20250826110419

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: 09/09/2025

NARRATIVE

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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

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Bernadette Allen
LICENSING EVALUATOR SIGNATURE:	DATE: 09/09/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/09/2025

LIC9099 (FAS) - (06/04)

Page: 4 of 4

Control Number 11-AS-20250826110419

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: 09/09/2025

NARRATIVE

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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

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Bernadette Allen
LICENSING EVALUATOR SIGNATURE:	DATE: 09/09/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/09/2025

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 11-AS-20250826110419

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: 09/09/2025

NARRATIVE

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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.

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Bernadette Allen
LICENSING EVALUATOR SIGNATURE:	DATE: 09/09/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/08/2025

LIC9099 (FAS) - (06/04)

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