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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198602567
Report Date: 02/13/2026
Date Signed: 02/13/2026 01:10:18 PM

Substantiated


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
01/28/2026 and conducted by Evaluator Antonine Richard
COMPLAINT CONTROL NUMBER: 11-AS-20260128122053
FACILITY NAME:REGENCY PALMS LONG BEACHFACILITY NUMBER:
198602567
ADMINISTRATOR:ROBERT JAKINIFACILITY TYPE:
740
ADDRESS:117 E 8TH STREETTELEPHONE:
(562) 432-9260
CITY:LONG BEACHSTATE: CAZIP CODE:
90813
CAPACITY:91CENSUS: 77DATE:
02/13/2026
UNANNOUNCEDTIME BEGAN:
12:16 PM
MET WITH:ROBERT JAKINITIME COMPLETED:
01:30 PM
ALLEGATION(S):
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Staff are not releasing resident's records to their responsible party as required.
INVESTIGATION FINDINGS:
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This complaint investigation report supersedes the report delivered on 01/30/2026 and the findings have been changed.
On 02/13/2026, Licensing Program Analyst (LPA) Antonine Richard conducted a subsequent visit to deliver findings. LPA met with Executive Director Robert Jakini and the purpose of the visit was explained.

Investigation consisted of the following: On 01/30/2026, LPA obtained Personnel Report, Register of Residents, Resident #1’s (R1) Resident Lease Agreement, Telecommunications Device Notification, Release of Resident Medical Information, Consent for Emergency Medical Treatment, Personal Rights, Facility Assessment Determination Addendum, Uniform Statutory Form Power of Attorney, and Provider Service Contract between LA Coast PACE, LLC and Regency Palms Senior Living. LPA interviewed Staff #1 - #4, Witness #1, and Residents #5 - #9. LPA attempted to interview R1 – R4 and Witnesses #2 - #5.

Report Continued on LIC9099C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Antonine Richard
LICENSING EVALUATOR SIGNATURE:

DATE: 02/13/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/13/2026
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 3
Control Number 11-AS-20260128122053
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: 02/13/2026
NARRATIVE
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Investigation revealed the following:

Allegation: Staff are not releasing resident's records to their responsible party as required.

Regarding the allegation, “Staff are not releasing resident's records to their responsible party as required, it is being alleged that the staff did not release Resident #1’s (R1) records to a third party with verbal consent from the Power of Attorney (POA). Record review of Provider Service Contract between LA Coast PACE, LLC and Regency Palms Senior Living (10/01/2023) revealed the facility agreed to release participants records in Article 4: Books, Records and Reports; Inspection. Review of R1’ Facility Assessment Determination Addendum (02/20/2024) revealed the facility services, PACE covered services, and daily reimbursement. Interview with W1, R1’s POA, indicated W1 provided verbal consent to the third party. W1 also indicated the facility has a contract with the third-party agency. Four out of five resident interviews (R5 – R9) were unable to confirm if the facility would release their medical records to self, family, or third parties.

Regarding the allegation, “Staff are not releasing resident's records to their responsible party as required,” based on record review and interviews, the preponderance of evidence standard has been met, therefore the above allegation(s) is found to be substantiated. California Code of Regulations, Title 22, is being cited on the attached LIC 9099D.

An exit interview was conducted, plans of correction developed, and a copy of this report with appeal rights was provided to the Executive Director Jakini Robert.
SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Antonine Richard
LICENSING EVALUATOR SIGNATURE:

DATE: 02/13/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/13/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 11-AS-20260128122053
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/13/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/27/2026
Section Cited
CCR
87468.2(a)(2)
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(2)To have their records and personal information remain confidential and to approve their release, except as authorized by law.
This requirement was not met as evidence by:
Based on records review and interviews, The Licensee did not release R1’s records
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POC Due Date: 02/27/26
POC: The Licensee will email evidence of correction to regina.cloyd@dss.ca.gov.

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as authorized by law which poses a potential personal right risk to client in care. A Contract between LA Coast PACE, LLC and facility commenced on 10/01/2023 which includes an agreement to provide participant records. Plus, R1’s POA provided consent.

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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Eva M Alvarez
LICENSING EVALUATOR NAME: Antonine Richard
LICENSING EVALUATOR SIGNATURE:

DATE: 02/13/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/13/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 3