198602567-10-17-2025-11-AS-SCIS-DNRQA4-20251125105906

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198602567
Report Date: 10/17/2025
Date Signed: 10/17/2025 03:21:14 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
12/09/2024 and conducted by Evaluator Elvira Gonzalez

COMPLAINT CONTROL NUMBER: 11-AS-20241209124307

FACILITY NAME:	REGENCY PALMS LONG BEACH		FACILITY NUMBER:	198602567
ADMINISTRATOR:	KENIA SANCHEZ PADILLA		FACILITY TYPE:	740
ADDRESS:	117 E 8TH STREET		TELEPHONE:	(562) 432-9260
CITY:	LONG BEACH	STATE: CA	ZIP CODE:	90813
CAPACITY:	91	CENSUS: 71	DATE:	10/17/2025
		UNANNOUNCED	TIME BEGAN:	08:11 AM
MET WITH:	Robert Jakini, Executive Director		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

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Facility is in disrepair.

INVESTIGATION FINDINGS:

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On 10/15/25, the department conducted a subsequent complaint visit to further investigate the above-mentioned allegations and deliver findings. The department met with Robert Jackini, Executive Director, and explained the reason for the visit. The department was granted access to the facility.

The investigation consisted of the following: On 12/10/24, the department requested a copy of the staff roster, and resident roster. The department reviewed service records for resident #1 (R1) and collected copies of the following documents: Resident Lease Agreement, Service Plan, Resident Assessment, Preplacement Appraisal Information, Identification and Emergency Information, Physician’s Report, Resident Personal Property and Valuables, Admissions Orders, Resident Notes, Resident Care Plan, Unusual Incident/Injury Report, and Staff schedule (for the dates of 11/25/24-11/28/24). The department conducted interviews with witness #1 (W1) and staff #1 (S1).

CONTINUED ON LIC9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Elvira Gonzalez
LICENSING EVALUATOR SIGNATURE:	DATE: 10/17/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/17/2025

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 11-AS-20241209124307

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: 10/17/2025

NARRATIVE

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Furthermore, the department conducted a tour of the facility and observed the residents to identify any signs of neglect, abuse or other immediate health and safety threats. On 12/12/24, the department conducted interviews with W1. On 12/13/24, the department conducted interviews with witness #2 (W2), S1. On 12/14/24, the department conducted interviews with W2. On 12/16/24, the department received Hospice Records from Valley Oaks Hospice, Inc. (dated: 12/01/24-12/16/24) for R1. On 12/19/24, the department received EMS records and 911 recording from Long Beach Fire Department. On 12/20/24, the department received the Death Certificate from R1 from Long Beach Department of Health and Human Services. On 12/24/24, the department conducted interviews with W2, and witness #3 (W3). On 12/26/24, the department conducted interviews with staff #2-#5 (S2-S5). On 12/17/24, the department conducted interviews with W1. On 12/31/24, the department conducted interviews with staff #6-S7 (S6-S7). On 01/06/25, the department conducted interviews with witness #4 (W4). On 01/07/25, the department conducted interviews with staff #8-#9 (S8-S9). On 01/09/25, the department conducted interviews with staff #10 (S10). On 01/13/25, the department received Home Health Records for R1 from Royal Majesty Home Care, Inc. On 01/14/25, the department conducted interviews with W1. On 01/15/25, the department received Medical Records from R1’s Gastroenterologist, SoCal Gastroenterology, Hospital Records from St. Mary Medical Center, and Medical Records from Provider 1st R1’s Primary Care Physician. On 01/28/25, the department conducted interviews with witness #5 (W5). On 01/31/25, the department conducted interviews with staff #11 (S11). On 02/03/25, the department conducted interviews with witness #6 (W6). On 02/04/25, the department conducted interviews with witness #7 (W7). On 02/06/25, the department conducted interviews with witness #8 (W8). On 02/10/25, the department conducted interviews with witness #9 (W9) and staff #12 (S12). On 02/11/25, the department conducted interviews with witness #10 (W10). On 02/12/25, the department conducted interviews with witness #11 (W11). On 02/14/25, the department conducted interviews with witness #12 (W12). On 02/19/25, the department conducted interviews with staff #13 (S13). On 02/21/25, the department conducted interviews with S1 and S4. On 02/25/25, the department conducted interviews with W1. On 02/28/25, the department conducted interviews with staff #14-#15 (S14-S15). On 03/07/25, the department received Imaging Records for R1 from St. Mary Medical Center. On 03/14/25, the department conducted interviews with W2. On 03/20/25, the department conducted interviews with witness #13 (W13). On 03/21/25, the department conducted interviews with witness #14-#15 (W14-W15).

Continued on LIC9099-

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Elvira Gonzalez
LICENSING EVALUATOR SIGNATURE:	DATE: 10/17/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/17/2025

LIC9099 (FAS) - (06/04)

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Control Number 11-AS-20241209124307

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: 10/17/2025

NARRATIVE

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On 10/15/25, the department requested a copy of the staff roster, resident roster, and the facility menu. The department conducted interviews with staff #2 (S2), staff #16-#20 (S16-S20), and residents #2-#7 (R2- R7). The department was unable to interview R1, as R1 passed away. On 10/17/25, the department conducted a tour of the facility and inspected rooms #306, and #303.

Allegation: Facility is in disrepair. It is being alleged that the facility has no hot water on the 3rd floor, including the kitchen, laundry and a residents room. On 10/15/25, the department conducted interview with S2 and staff #16-#20 (S16-S20)). Of those interviewed, 6 out of 6 staff denied the allegation. 6 out of 6 staff said they have not taken a resident to shower in another residents bathroom because there was no hot water in their bathroom. 5 out of 6 staff said they did not know if R1 was ever taken to another residents bathroom because there was no hot water in their bathroom, and 1 out of 6 staff said R1 was never taken to another residents bathroom because there was no hot water in their bathroom.

On 10/15/25, the department interviewed R2-R7, and were unable to interview R1, as they passed away. Of those interviewed, 6 out 6 residents denied the allegation. 6 out of 6 residents said there is hot water running in their bathroom and through the whole facility. 6 out of 6 residents said they have never been taken to another residents bathroom to shower due to no hot water running in their bathroom. 6 out of 6 residents said they did not know of a resident being taken to another residents bathroom to shower due to no hot water running in their bathroom.

On 12/10/24, the department conducted a tour of the facility, and inspected rooms #306, #305, #303, #308, laundry room, and the kitchen. During the tour and inspection, the department observed the facility to be clean and sanitary. The water temperature properly measured between 105. F and 120. F in all rooms inspected, including the laundry room, and kitchen. The department observed the facility to be in good repair.

On 10/17/25, the department conducted another tour of the facility, and inspected rooms #306, and #303. During the tour and inspection, the department observed the facility to be clean and sanitary. The water temperature properly measured between 105. F and 120. F in all rooms inspected. The department observed the facility to be in good repair.

Continued on LIC9099-C

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Elvira Gonzalez
LICENSING EVALUATOR SIGNATURE:	DATE: 10/17/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/17/2025

LIC9099 (FAS) - (06/04)

Page: 6 of 7

Control Number 11-AS-20241209124307

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: 10/17/2025

NARRATIVE

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Based on the information gathered, interviews conducted, and records reviewed, the Department found no evidence to support the allegation mentioned above. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation, did or did not occur, therefore the allegation is Unsubstantiated.

An exit interview was conducted, and a copy of the report was provided to Robert Jakini, Executive Director.

SUPERVISORS NAME: Stephanie Cifuentes
LICENSING EVALUATOR NAME: Elvira Gonzalez
LICENSING EVALUATOR SIGNATURE:	DATE: 10/17/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/17/2025

LIC9099 (FAS) - (06/04)

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