198602567-4-3-2026-11-AS-JHAD-DSWRM4-20260407130806

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198602567
Report Date: 04/03/2026
Date Signed: 04/03/2026 03:09:31 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
03/22/2026 and conducted by Evaluator Zina Brown

PUBLIC

COMPLAINT CONTROL NUMBER: 11-AS-20260322123019

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: 71	DATE:	04/03/2026
		UNANNOUNCED	TIME BEGAN:	12:40 PM
MET WITH:	Robert Jakini (Adminstrator)		TIME COMPLETED:	03:15 PM

ALLEGATION(S):

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Staff did not adequately address a change in resident’s condition.

INVESTIGATION FINDINGS:

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On 04/03/2026 at 12:40pm, the department conducted an subsequent visit at this facility to deliver the complaint investigation findings for the allegation above. During today’s visit, the department met with Robert Jakini (Administrator) and explained the purpose of the visit.

The investigation consisted of the following: On 03/24/2026 at 8:45am the department conducted interviews with Administrator (A1), Staff (S1-S3) & Residents (R1- R10), between the hours of 9:25am - 11:43am and requested the following documentation: Staff Roster (received 03/24/2026), Resident Roster (received 03/24/2026), Staff Schedule (dated 03/15/2026 - 03/21/2025 Resident 1's (R1), records such as Admission Agreement (dated 02/19/2024) LIC 601: Identification & Emergency Information (dated 02/18/2024), LIC 602: Physician Report for Residential Care Facilities for the Elderly (RCFE) (dated 04/23/2025), LIC 603: Preplacement Appraisal Information (dated 02/20/2024), Service Plan (dated 07/29/2025), Medication Administration Record (January - March 2026), Communication Logs (dated 10/2025), Certificate of Acknowledge of Notary Public (dated 04/20/2023), LIC 624 Unusual Incident/Injury Report (dated 01/05/2026 & 02/27/2026), Regency Palms Senior Living Standard Operating Procedures (revision date 01/01/2026) and Email Correspondent (dated 03/20/2026).

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Zina Brown
LICENSING EVALUATOR SIGNATURE:	DATE: 04/03/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/03/2026

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-20260322123019

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: 04/03/2026

NARRATIVE

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The investigation revealed the following:

Allegation: Staff did not adequately address a change in resident’s condition.
It was alleged the resident had not been acting like themselves for several days and that the resident's urine had a strong, unpleasant odor, which are symptoms consistent with a urinary tract infection. It was further alleged that facility staff failed to notify the resident's healthcare provider of the observed changes in condition, despite the healthcare provider being the resident's primary care coordinator.

On 03/24/2026 between the hours of 10:20am - 10:30am, the department interview the Administrator (A1) in regards to the allegation.A1 denied the allegation. A1 stated the facility had no prior knowledge of any change in the resident's condition before 03/20/2026, as the resident was at her normal baseline and did not present with any symptoms of concern. A1 mentioned on the evening of 03/19/2026, the resident's family informed a MedTech that the resident had a UTI and would take the resident for evaluation. A1 stated the facility was not aware of a confirmed diagnosis until after the resident was seen by Welbe Health and that the family had already contacted Welbe directly. A1 stated the facility's protocol for a suspected UTI is to request a urinalysis from the appropriate medical professionals and follow all guidance provided, including medication administration.

On 03/24/2026 between the hours of 9:25am -10:18am, the department interview 3 staff in regards to the allegation.
3 out of 3 staff denied the allegation. Staff stated they did not observe or receive notification of any change in the resident's condition prior to 03/20/2026 and that Welbe Health was not notified because no change in condition had been identified. Staff stated the facility's protocol when a change in condition or suspected UTI is identified is to report to the MedTech, who is then responsible for notifying the healthcare provider.

On 03/24/2026 between the hours of 10:36am - 11:43am, the department 10 residents in regards to the allegation
1 out of 10 residents confirmed having a UTI but was unable to confirm how the facility staff addressed this situation. R1 recalled not feeling like themselves and noticing changes around 03/20/2026, and understands that their family member is the POA. 8 out of 10 Residents denied the allegation and stated staff respond to their medical needs in a timely manner. 1 out of 10 Residents did not confirm nor deny the allegation and stated staff do not respond to medical needs in a timely manner and that there has been a time when a request for medical help was not followed through.

On 04/02/2026, between the hours of 9:45am – 1:54pm, the department corresponded with Witness 1 (W1) in regards to the allegation.W1 confirmed the allegation. W1 stated that behavioral changes were first observed on 03/18/2026 by R1's private caregiver and that facility staff were notified of concerns regarding a possible UTI on 03/19/2026. W1 stated the facility took no action, did not notify Welbe Health, and that the family themselves transported the resident to Welbe Health on 03/20/2026, where the resident tested positive for a UTI.

Report continues on LIC 9099-C

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Zina Brown
LICENSING EVALUATOR SIGNATURE:	DATE: 04/03/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/03/2026

LIC9099 (FAS) - (06/04)

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Control Number 11-AS-20260322123019

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: 04/03/2026

NARRATIVE

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On 04/02/2026 between the hours 2:50pm - 3:45pm, the department conducted a records review and observed the following: For R1's LIC 602A (dated 04/23/2025) indicated the resident has bladder impairment and is incontinent. For R1's LIC 603A (dated 02/20/2024) noted moderate bladder impairment with incontinence and indicated the resident needs assistance with toileting and incontinence care. R1's Service Plan (dated 07/29/2025) indicated the resident requires reminders, verbal cues, and assistance with incontinence care in the AM, PM, and nighttime, with a toileting schedule to be followed by female staff only.
The Regency Palms Senior Living Standard Operating Procedures (revision date 01/01/2026), under the Significant Change of Condition Policy, requires the facility to promptly identify, report, evaluate, and address any significant change in a resident's physical, cognitive, or behavioral condition and to coordinate with the resident, responsible party, and medical providers. The policy notes that a significant change is not an established, predictive, cyclic pattern such as frequent urinary tract infections.
The Medication Administrator Record (MAR) for March 2026 shows R1 was prescribed Nitrofurantoin Mono-MCR 100 MG (as of 03/23/2026) to be taken twice for five (5) days with the stop date on March 28, 2026. Per the MAR it is documented that R1 was administered the Nitrofurantoin Mono-MCR 100 MG from March 23, 2026 - March 28, 2026.

Unsubstantiated: Based on information gathered through interviews and record reviews, there is not enough 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.

Exit interview conducted with Robert Jakini (Administrator) and a copy of this report was provided

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Zina Brown
LICENSING EVALUATOR SIGNATURE:	DATE: 04/03/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/03/2026

LIC9099 (FAS) - (06/04)

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