Regency Palms Long Beach.

The investigation revealed the following Allegation 1: Staff do not ensure that resident has a sanitary drinking dish At 9:35 AM , LPA attempted to interview R1, who was not willing to engage in a conversation. LPA observed R1 with a purple thermos. R1’s personal companion opened the thermos, which was filled with water, and no mold was observed. LPA did observe other residents drinking water or juice from clear cups during the visit. At 9:45AM, LPA conducted interviews with staff members (S1–S7) and 7 out of 7 staff members stated that staff ensure residents’ cups are cleaned and sanitized daily throughout the day. Staff reported that residents typically receive only water in their personal bottles/cups. Juices are served in facility provided clear cups, which are cleaned after each use. When asked if mold had ever been seen in any residents’ personal cups, 7 out of 7 staff members stated they had not observed mold in any cups. When asked if residents are allowed to drink from their own personal cups, 7 out of 7 staff members stated yes, and that personal cups are also cleaned and sanitized daily. LPA Allen interviewed Witness (W1), who stated they heard about R1’s personal cup having mold but they did not personally observe any mold during the week of 10/20/2025 through 10/24/2025. W1 stated R1 normally drinks orange-colored Pedialyte in their personal cup. When asked if staff clean and sanitize the cup, W1 responded yes. LPA was able to interview the remaining residents and 6 out 7 residents stated they have not had mold in their personal cups or in cups provided by staff. When asked if staff clean their personal cups, 6 out of 7 residents stated yes. Continued 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 Although the allegation suggests that staff do not ensure residents have sanitary drinking dishes, evidence gathered through observations, interviews with staff and residents, and a review of documentation did not support this claim. Based on interviews conducted, documents reviewed, and observations made, 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 violation did or did not occur. An exit interview was conducted where this report was discussed and provided to Robert Jakini-Administrator, at conclusion of the visit with appeal rights.

Record review of daily menu revealed four salad options, four side options, and seven sandwich/wrap//burger options (including peanut butter and jelly sandwiches) are alternative options to the weekly menu. Review of weekly menu revealed breakfast, lunch, and dinner options with the snack selection (not distinguished). Review of lunch and dinner order sheet includes an order column for peanut butter and jelly and other alternative menu selections. Review of admission agreement revealed three nutritionally well-balanced meals and snacks made available daily as specified in Title 22, Section 87555, General Food Service Requirements. Five out of six staff interviews (S2 – S5, S7 – S8) - indicated the daily menu is an alternative to the weekly menu. Six out of seven staff interviews (S2 – S8) indicated residents are allowed to have additional food servings when requested. Seven out of seven staff interviews (S2 – S8) indicated snacks are available to residents in memory care. Six out of six resident interviews (R1 – R5, R7) - indicated they can receive alternatives, including peanut butter and jelly, from the daily menu. R6 assumes alternatives will be provided. Four out of four resident interviews (R1 – R4) indicated they are allowed to have additional food servings when requested. R5 – R7 indicated additional servings has not been requested. One out of two witnesses/responsible parties do not have any complaints about the food services. LPA observed three small snack (fruit) serving trays and peanut butter and jelly supplies in the kitchen. LPA observed residents eating lunch and alternative meals (fish, and sandwich with chips) being served. Regarding the allegation, “ Staff denies residents food ,” based on record review, interviews, and observations, the Department 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. Exit interview conducted with Robert Jakini (Administrator) and a copy of this report was provided.

On 04/23/2026 at 11:35 AM, the Department arrived at the facility to conduct a case management visit related to Complaint Control # 11-AS-20260403094602. Upon arrival, the Department met with Administrator Robert Jakini and explained the purpose of the visit. During today’s visit, the Department requested the following records such as Consent Forms, Admission Agreements, and LIC 602 Physician’s Reports for Residents R8 through R11 as well as conducted interviews with R8 - R11 between the hours of 11:55am - 12:41pm. The Department requested Power of Attorney (POA) documentation be submitted no later than the end of the day tomorrow on 04/23/2026. These documents were collected to further assess Complaint Control # 11-AS-20260403094602. Due to insufficient information available at this time, the case management incidents needs further investigation. An exit interview was conducted with Robert Jakini (Administrator) and copy of this report was provided.

LIC 602: Physician Report for Residential Care Facilities for the Elderly (RCFE) (dated 08/01/2025) , , LIC 621 Resident Personal Property & Valuables (dated 12/20/2024) LIC 613 Personal Rights (dated 12/20/2024) Resident Assessment (dated 12/31/2025), Service Plan (dated 07/29/2025), Medication Administration Record (January - March 2026), Communication Logs (dated 03/01/2026 & 03/03/2025. Alert Report for Care Predict (03/01/2026), Staff Schedule (dated 02/22/2026 - 03/07/2026) and Notice of Employee as to Change in Relationship (03/05/2026). The investigation revealed the following: Allegation: Facility staff did not seek timely medical attention for resident. It was alleged that facility staff did not obtain urgent medical assistance for a resident after the resident experienced a fall and later reported feeling ill with numbness on one side of the body. It was further alleged that staff delayed contacting emergency services and instead arranged non-emergency transport several hours after the resident’s symptoms were reported. The resident was subsequently transported to a hospital, where diagnostic testing determined the resident had suffered a stroke On 03/11/2026 between the hours of 10:52am - 11:49am, the Department conducted an interview with the Administrator (A1) regarding the allegation. A1 denied the allegation. A1 stated the resident showed no signs of injury after the fall and initially denied pain. A1 reported that later in the morning the resident complained of soreness on the left side, and the Medtech on duty contacted non-emergency medical transport because the resident did not appear to be in immediate distress. A1 explained that staff made this decision rather than wait for the R1's family member who was called multiple times and did not answer to transport the resident, as staff had previously received pushback from the fire department for calling 911 for situations they considered non-emergencies. A1 stated that staff were instructed that moving forward, 911 should be contacted when a resident shows any concerning symptoms, and if the fire department has concerns, they are to contact the Administrator directly. A1 reported that staff assessed the resident, notified the resident power of attorney, and arranged transport consistent with their understanding of protocol at the time. Report continues on LIC 9099-C 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 On 03/11/2026 between the hours of 8:45am - 3:06pm, the Department conducted six (6) staff (S1–S6) interviews regarding the allegation. 4 of 6 staff denied the allegation. 2 of 6 staff were aware of the incident but did not confirm nor deny the allegation. Staff reported that the resident fell during the overnight shift, initially with resident denying pain, and appeared stable. Staff stated that the next day in the morning the resident reported left-side discomfort, and initial contacted non-emergency dispatch and Premier transport was contacted. Some staff reported attempts to contact the resident family member multiples times, while other staff stated that 911 was not called immediately after the fall because the resident initially felt no pain. Staff described following internal communication procedures and notifying supervisors. On 03/11/2026 between the hours 11:20am - 11:47am and 03/12/2026 between the hours of 10:45am - 11:10am, the department conducted 11 resident interviews.  11 of 11 residents denied the allegation. Residents generally reported that  staff respond to their needs in a timely manner, feel safe in the facility, and did not report concerns about delays in medical care. One resident who experienced the incident stated staff assisted and medical help was obtained, though transport which took time. The residents had no knowledge of the incident or reported no issues with staff responsiveness. On 04/10/2026, between 2:32 pm - 4:00pm, the Department conducted a record review and observed the following: on 03/01/2026 at 3:39 am, the facility’s wearable monitoring system detected a fall involving the resident. According to incident notes created on 03/03/2026, the resident reported falling while reaching for a remote and landing on their buttocks, which was also documented in a facility group text message at 5:53am on the same date. The notes further indicated that at 10:24 am, the resident reported difficulty moving the left side of their body, and non-emergency medical transport was contacted for evaluation. Staff documented multiple attempts to contact the resident’s responsible party at 5:36 am, 11:30 am, and 11:41 am, with voicemail inbox full, and a text message was sent notifying the responsible party that the resident was being transported for evaluation. Staff documented that the resident was assessed with no visible injuries such as bumps or bruising. Records also showed that the resident later complained of left-side pain at 1:45 p.m. and was transported to the hospital. A progress note dated 03/02/2026 at 1:57pm indicated that the hospital initially reported no stroke on CT scan, but an MRI later confirmed a stroke. Report continues on LIC 9099-C 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 Hospital records from 03/01/2026 - 03/05/2026 documented that the resident was admitted with left-sided weakness. A CT scan initially showed no acute findings. An MRI performed on 03/01/2026 revealed an “acute/recent patchy infarct in the posterior right frontal lobe/precentral gyrus,” confirming an acute ischemic stroke. The resident remained hospitalized through 03/05/2026, receiving dual anti platelet therapy, statin therapy, neurological monitoring, and rehabilitative services. Upon further review, according to the National Institutes of Health (NIH), common symptoms of an acute stroke include sudden weakness or numbness on one side of the body, difficulty speaking, facial drooping, or loss of coordination, which are consistent with the left sided weakness documented in the hospital record. Based on information gathered through interviews and record reviews, there is not enough evidence to support allegation that staff knowingly delayed emergency medical care or failed to respond when symptoms were reported. 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.

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 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 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

Continued LIC9099-C page 2. Investigation revealed the following: Allegation: Staff does not ensure residents receive correspondence in a prompt manner. It was alleged that staff fail to ensure residents receive their mail in a prompt manner. On 03/17/2026, between 10:25 a.m. and 2:30 p.m., LPA Bunker interviewed staff members S1–S3. All 3 out of 3 staff members stated that the facility ensures residents receive their correspondence in a timely manner. 3 out of 3 staff members explained that when mail is delivered by the mail carrier, it is immediately sorted, separated by floors, and distributed to residents in the Assisted Living Unit (ALU) by the end of the day. 3 out of 3 staff members stated that mail for residents in the Memory Care Unit (MCU) is held at the front desk in a locked, sorted cabinet. This process is in place because residents in the MCU have dementia and are unable to manage or keep track of their mail. According to S1–S3, mail for MCU residents is released only to responsible parties, family members, or the Power of Attorney (POA) upon request. Staff emphasized that they do not provide resident mail to anyone who is not the designated responsible party. 3 out of 3 staff members reported that the resident’s mail in question had accumulated for approximately four months because the POA was not picking up the mail, despite staff’s attempts to contact the POA. Staff stated that the mail continued to pile up and that family members frequently came in on weekends after hours requesting the mail, which could not be released at those times because it was secured. S1 stated that they reached out to the POA and offered either to mail the resident’s correspondence directly to them or to arrange a specific time for the mail to be picked up from the facility. All three staff members confirmed that the facility has established procedures to ensure residents receive their correspondence in a timely manner and denied the allegation. During today's visit, LPA Bunker also observed staff actively distributing mail to residents. On 03/17/2026, between 10:25 a.m. and 2:30 p.m., LPA Bunker conducted interviews with residents R1–R5. 5 out of 5 residents stated that staff ensure they receive their mail in a prompt and timely manner and reported no issues with receiving their correspondence when it is delivered by the mail carrier. Three out of three residents interviewed regarding this allegation denied that staff fail to provide mail in a timely manner. See continued LIC9099-C page 2. 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 Continued LIC9099-C page 3. Based on interviews, available evidence, observation, information received, and records reviewed, there was not enough sufficient 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 deemed unsubstantiated. There were no deficiencies cited. A copy of the Complaint Investigation Report LIC9099 and LIC9099-Cs was provided to Robert Jakini, Executive Director. An exit interview was conducted.

INVESTIGATION REVEALED THE FOLLOWING: Allegation: Staff did not notify resident's responsible party of a change in resident's condition. It is alleged that the facility failed to notify the party responsible of Resident #1 (R1) regarding a change in the resident’s condition. Reports indicate that (R1) began exhibiting symptoms of a stroke on Saturday, February 28, 2026, yet the facility did not inform the responsible party. While it is unclear whether (R1) had a stroke on February 28, 2026, there was a noticeable change in condition, and no responsible party was notified. The following day, March 1, 2026, (R1) fell; however, the party responsible was not informed of the severity of the fall. The reports indicate that the fall occurred when (R1) reached for a television remote. No additional information has been provided regarding this incident. On March 12, 2026, between 10:45 AM and 11:10 AM, the Department interviewed a resident member identified as Resident #1. (R1) remembered feeling unwell on February 28, 2026, and then experiencing a fall. R1 said that (R1) didn't know exactly how (R1) felt but was sure (R1) did not feel well. After going to the hospital, doctors diagnosed (R1) with a mild stroke based on an MRI scan, which showed it affected the left side of (R1's) body. (R1) explained that when (R1) felt unwell, the facility staff responded immediately and called for medical assistance; however, Emergency Medical Services (EMS) did not arrive promptly. During the interview, (R1) confirmed that the person responsible for (R1) was informed about (R1's) health change. (R1) also said this person was allowed to talk with (R1). (R1) described the fall as happening when (R1) reached for the television remote, lost balance, and slipped. (R1) agreed to go to the hospital for treatment. Overall, R1 reported that the facility staff treated (R1) well, responded quickly to (R1's) needs, and always provided (R1) with medical help. On March 12, 2026, between 11:30 AM and 1:00 PM, the Department interviewed staff members identified as Staff #1 through Staff #4 (S1-S4). Three (3) out of the four (4) staff members could not corroborate this claim. All staff members confirmed that the family representative was notified. They explained that on the evening of February 28, 2026, the resident (R1) did not feel well, but staff did not consider it a significant change in the resident's condition as (R1) was fine the day before. (Evaluation Report continues) 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 Staff members (S2-S4) stated they are not trained medical professionals and indicated they could not determine if (R1) was experiencing a stroke. This was only verified after (R1) was hospitalized and had a (MRI). Prior to the (MRI) the hospital contacted the facility and made the medical assessment that (R1) did not have a stroke. Even the hospital was uncertain. During the assessment at the facility, (R1) reported feeling unwell but did not want to request medical attention. The following morning, (R1) experienced a fall and even then (R1) refused medical attention Staff assisted (R1), who claimed to have no injuries that would require calling 9-1-1. During this time, facility staff attempted to contact the family representative several times by phone and text, but there was no response. (S2-S4) explained that the proper procedure for care staff is to notify the medication technician if they observe a change in a resident's condition, who will then report to the Wellness Nurse. However, (S2-S4) clarified that the facility took proactive measures by contacting 9-1-1 after (R1) fell, and non-emergency paramedics and EMTs determined that the situation was non-emergency. The Department reviewed Resident #1 (R1’s) Medical Assessment for Residential Care Facilities for the Elderly LIC 602A (dated 08/01/25), Identification and Emergency Information LIC 601 (dated 12/20/24), Resident Assessment (dated 12/31/25), Unusual Incident Report LIC 624 (dated 03/03/26), St. Mary’s Hospital Medical Records, Email Communications (dated 03/06/26) and Durable Power of Attorney for Management of Property and Personal Affairs (dated 06/15/24). Further review of Communication Logs (dated 03/01/2026 & 03/03/2025), Alert Report for Care Predict (03/01/2026), Staff Schedule (dated 02/22/2026 - 03/07/2026) and Notice of Employee as to Change in Relationship (03/05/2026) verified that (R1’s) was notified multiple times on March 1, 2026, between 05:27 AM and 11:41 AM with phone calls and messages. The Community Care Licensing Unusual Incident Report LIC 624 revealed the family representative was notified. Based on the information gathered, there is not enough evidence to support the allegation mentioned above. Based on the information gathered from the facility, observations, interviews, and records analysis, the Department found no evidence to support the above allegation. The allegation may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violation occurred. Therefore, the allegation is Unsubstantiated . An exit interview was conducted with Robert Jakini, and copies of the reports were provided.

Allegation: Staff do not ensure resident’s incontinence needs are met. The allegation alleges that during the night the caregivers do not check on them or change their diapers. During the facility inspection, LPA observed staff asking residents if they need to go to the restroom or if they need changed. During record review, LPA received and reviewed Resident R1’s Service Plan (dated 07/29/2025) that indicates R1 requires assistance with PM and nighttime incontinent care. LPA observed safety checks are to be done four (4) times per shift is listed as a Special Care Need. LPA received and reviewed Resident R1’s Physician Report (dated 09/30/2024) that comments patient requires assistance with toileting. Additionally, LPA received and reviewed Staff S2-S10 training records that indicate staff have received the following training on Relias within the last year, Restorative Nursing: Bowel and Bladder for the CNA, Managing Urinary Incontinent, and Care of the Bedridden Individual. LPA received and reviewed In-Service logs regarding Handling Residents with Care while Providing Incontinent Care, Peri Care, Toileting Log, and Incontinent Supplies. During interviews with Staff S1-S10, were asked how often residents are checked/assisted with changing briefs/diapers, ten (10) out of ten (10) stated they are checked/assisted every 30 minutes to two (2) hours depending on the residents. Additionally, Staff S1-S10 were asked if there was a time when they came into work and observed a resident in soiled diapers, seven (7) out of ten (10) stated no, they have not come into work and found a resident in soiled briefs/diapers. Three (3) out of ten (10) stated there was a time when they have come in and a resident was soiled, and they were informed during crossover, the resident at the time was refusing assistance with being changed. During interviews with Residents R1-R7, they were asked if there has been a time they were left in soiled diapers for an extended period of time, three (3) out of seven (7) stated no they have not been left in soiled diapers or briefs for an extended period of time. Two (2) out of seven (7) stated they had been left in soiled diapers for 5 to 15 minutes due to staff assisting other residents. Two (2) out of seven (7) stated they do not require assistance changing their briefs. Additionally, during interviews Residents R1-R7, were asked if staff check on them during the night to see if they need changed, five (5) out of seven (7) stated yes, staff come and check on them at night to see if their diaper or briefs need changed. Two (2) out of seven (7) stated they are not sure if staff check to see if they need changed at night. 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 Allegation: Staff do not assist residents with repositioning. The allegation alleges that staff do not help a resident reposition for meals. During the facility inspection, LPA observed staff bring lunch to residents’ rooms. For residents who were having their meal in bed, LPA observed staff assist the residents up higher on the mattress before they raised the resident’s head. During record review, LPA received and reviewed resident R1’s Service Plan (dated 07/29/2025) that indicates R1 requires support with ambulation, mobility and repositioning. An added note states “Provide additional staff support to help with repositioning in bed. Additionally, LPA received and reviewed Staff S2-S10 training logs that indicate staff have received the following training on Relias within the last year, Assisting With Proper Positioning, Promoting Safe Eating, and Care of the Bedridden Individual. LPA received and reviewed In-Service training logs regarding Transfers/2 person assist and Rotating Bed Bound/Wheelchair Bound Residents. During interviews with Staff S1-S10, were asked if residents are assisted with proper positioning before receiving their meals, ten (10) out of ten (10) stated yes, they ensure the residents who are non-ambulatory or bedridden are positioned properly before eating meals. During interviews with Residents R1-R7, were asked if staff ensure they are positioned properly during meals, six (6) out of seven (7) stated yes staff ensure they are positioned properly. One (1) out of seven (7) stated they do not require assistance with positioning during meals. During the course of the investigation, LPA was unable to find evidence to support the allegation(s). Although the allegation(s) may have happened or is valid, there is no preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation(s) is/are unsubstantiated . During today’s visit, LPA did not observe or cite any deficiencies. An exit interview was conducted with Executive Director, Robert Jakini, and a copy of this report was provided.

Investigation revealed the following: 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 Uniform Statutory Form Power of Attorney (04/20/2023) revealed Witness #1 (W1) has all financial powers for R1. Review of R1’ Facility Assessment Determination Addendum (02/20/2024) revealed the facility services, PACE covered services, and daily reimbursement. Review of Release of Resident Medical Information (02/13/2024) revealed R1’s Primary Care Physician is authorized to release R1’s medical or confidential information to the facility. LPA did not observe release of resident medical information to the third party. Interview with the Executive Director (S1) indicated staff cannot release records without the family’s permission. Interview with Staff #3 indicated a release form is required for records and the facility will also speak with their consultants and counsel for advice. Interview with W1 indicated W1 did not provide written consent to the third party nor to the facility. 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,” although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated. An exit interview was conducted and a copy of this report with was reviewed the Executive Director and left with Staff Alyssa Rios.

Preplacement Appraisal Information (Dated: 9/16/2024 & 8/24/2024), Incident Reports (Dated: 3/13/2025 & 4/13/2025), Unauthorized Use Of Cameras Warning Notice (Dated: 05/08/2025), and Eviction Notice (Dated: 05/21/2025) from the facility. The investigation revealed the following : Allegation #1-Staff does not provide adequate supervision resulting in resident physically abusing another resident(s). The details of the complaint alleged that the facility does not provide adequate supervision, leading to conflicts and altercations with the residents. On 09/17/25, from 9:30am-2:00pm, the department interviewed staff (S1-S4) and residents (R1-R8) regarding the allegation. 4 of 4 staff denied the allegation that Staff does not provide adequate supervision resulting in resident physically abusing another resident(s). All staff (S1-S4) stated the facility has more than enough staff to provide adequate care and supervision for the residents. They also state that on occasion some residents do have behavior problems and arguments with other residents and staff. They state that when these situations occur, there are staff present and available to counsel, coach, and redirect the resident’s behavior and to prevent things from going any further. They further state that when a resident makes contact with staff or another resident, it is documented and reported to the Community Care Licensing Division (CCLD), the resident’s physician, Ombudsman, family, and any other parties that may have power of attorney over the resident. The department interviewed residents (R1-R8) about the allegation and 8 of 8 residents that were interviewed stated that there is enough staff to adequately care for and supervise the residents in the facility. They also stated that they feel safe living in the community among the staff and the other residents. The department reviewed the Staff Roster (Dated: No Date), Incident Reports (Dated: 3/13/2025 & 4/13/2025), Resident Assessment (Dated: 07/29/25 & 4/24/2025), and Preplacement Appraisal Information (Dated: 9/16/2024 & 8/24/2024) and observed that the facility has enough staff to meet the needs of the residents served. Report Continued on LIC9099-C 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 department did not find any evidence that the facility failed to have proper staffing, causing the residents to be unsupervised. Based on interviews, and records reviewed, there is insufficient evidence to support the allegation that Staff does not provide adequate supervision resulting in resident physically abusing another resident(s). 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 . Allegation #2- Staff is wrongfully evicting resident. The details of the complaint alleged that the facility is wrongfully evicting the resident (R1) because of cameras in the residents’ room and violating general policies. On 09/17/25, from 9:30am-2:00pm, the department interviewed staff (S1-S4) and residents (R1-R8) regarding the allegation. 4 of 4 staff denied the allegation that Staff is wrongfully evicting resident. Staff (S1) stated that the resident (R1) was not wrongfully evicted. S1 stated that an eviction notice was issued to R1 on 05/21/2025, due to violating the facilities admission agreement. S1 stated that use of unauthorized video surveillance devices with an audio component, was a contributing factor to the eviction notice, which is not allowed at the facility as stated in the admission agreement which was signed by R1s responsible party on 08/24/2024. S1 further stated that the resident violated other general policies of the facility, such as violent behavior towards staff and other residents. The department interviewed residents (R1-R8) about the allegation and 7 of 8 residents that were interviewed stated that they have not been issued an eviction notice or are being wrongfully evicted. They state that they are happy living at the facility and feel safe in their community. The department reviewed the Eviction Notice (Dated: 05/21/2025), Unauthorized Use of Cameras Warning Notice (Dated: 05/08/2025), and the Resident Lease Agreement (Dated:08/24/2024). The department observed that the resident was in violation of the general policies of the facility as outlined in section 10.9 of the resident’s lease agreement and for violating Title 22 regulations section 87224(a)(3) Eviction Procedures: Failure of the resident to comply with general policies of the facility. Report Continued on LIC9099-C 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 Additionally, another general policy of the facility was violated by the resident, which are the House Rules section 7.7 of the resident’s lease agreement that states, “residents should be respectful to all staff and residents, and further states that failure to comply with this rule may result in the issuance of a 30-day notice”. The facility staff (S1) stated the resident was violent towards staff and residents. The department has confirmed that the eviction notice was sent to Community Care Licensing Division within 5 days of issuance and based on the review of the notice, it is in compliance with Title 22 regulations. Based on interviews, and records reviewed, there is insufficient evidence to support the allegation that Staff is wrongfully evicting resident. 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 because of neglect, therefore the allegation is Unsubstantiated . No citations were issued. An exit interview was conducted with Robert Jakini, Executive Director, and a hard copy of this Complaint Investigation Report was provided.

The investigation revealed the following: Allegation: Staff did not prevent a resident from developing multiple pressure injuries while in care. It was alleged that a resident developed a pressure injury on the buttock area that was approximately the size of a grapefruit. It was further alleged that the pressure injury was severe, with visible muscle and tissue exposed and no skin covering the affected area. Additionally, it was alleged that the resident had two additional pressure injuries located on the hips. The reporting party was unsure of the staging of these pressure injuries. On 11/04/2025, between the hours of 11:25am -  11:45am, the LPA interviewed Administrator (A1) regarding the allegation. A1 denied the allegation and stated the wound is unstageable and located on the coccyx of the resident. The facility defers wound care to the hospice care nurse, and the facility only changes dressings if soiled. A1 also mentioned the resident is repositioned as needed and has been provided an alternating pressure mattress (APP) that inflates and deflates to relieve pressure. The wound care nurse sees R1 three times a week, with the wound being cleaned, bandages changed, and debridement performed. On 11/04/2025, between the hours of 8:42 am -12:20pm, the LPA interviewed 7 staff regarding the allegation. 4 of 7 staff members denied the allegation and stated there were no concerns with staff properly repositioning or cleaning pressure injuries as directed by the facility and the wound care nurse. 3 of 7 staff members did not confirm nor deny the allegation and stated not working on the floor that the resident resides and did not express any concerns repositioning or cleaning the resident's pressure injury. On 11/04/2025, between the hours of 9:09am - 10:47am, the LPA interviewed 6 residents regarding the allegation. 6 of 6 residents denied the allegation and stated they have never experienced having any pressure injuries nor receiving wound care from a nurse. On 11/04/2025, LPA observed in R1's room that the facility provided the resident with a mattress that is specific for non-ambulatory or bedridden residents to help minimize pressure injuries. Report continues on LIC 9099-C 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 On 12/22/2025 between the hours of 3:00pm - 4:30pm, LPA reviewed R1's LIC 602 Physician's Report for Residential Care Facilities for the Elderly (RCFE) (dated on 05/28/2025) which states on page 3 of 6 that Resident 1 (R1) has a history of skin breakdown located on sacral and buttocks areas. LPA conducted a records review of R1's Service Plan (dated 07/25/2025) on page 4 of 8 which states under Special Care Need resident has active wounds/skin breakdown with a history of open skin to heels and or coccyx area. Also under the transfer section of the service plan on page 3 of 8 the resident receives two person assistance with transferring and repositioning on a daily bases. LPA reviewed Hospice Care Plan from Compassionate Hospice Care, Inc (dated 11/13/2024) stated R1's treatment consist of bilateral buttocks skin care maintenance: Wash with mild soap and rinse: thoroughly with warm water, pat dry, apply calmoseptine ointment topically to buttocks skin and leave open to air daily and as needed. LPA reviewed Wound Care Progress Notes from Compassionate Hospice Care, Inc./Empire Wound Care for Resident 1 (R1). Documentation dated 10/03/2025 indicated R1 had multiple wounds, including a Stage 4 pressure injury located at the center midline sacrococcyx with a duration of greater than two years and pre-debridement measurements of 4.6 cm x 8.6 cm x 0.4 cm. R1 also had a wound on the left medial second toe with a duration of six weeks and pre-debridement measurements of 0.7 cm x 0.5 cm x UTD. In addition, R1 had a Stage 3 pressure injury on the left posterior distal buttocks with a duration of four weeks and pre-debridement measurements of 3.1 cm x 2.5 cm x 0.1 cm, as well as a Stage 3 pressure injury on the right posterior distal buttocks with a duration of six weeks and pre-debridement measurements of 3.5 cm x 2.5 cm x 0.1 cm. On 10/10/2025, which indicated the center midline sacrococcyx wound remained at Stage 4 with pre-debridement measurements of 4.3 cm x 8.5 cm x 0.3 cm and post-debridement measurements of 4.4 cm x 8.6 cm x 0.4 cm. The left medial second toe wound remained at the same stage with a seven-week duration and pre-debridement measurements of 0.7 cm x 0.5 cm x UTD, with no post-debridement measurements documented. The left posterior distal buttocks wound remained Stage 3 with an eight-week duration and pre-debridement measurements of 3.1 cm x 2.3 cm x UTD and post-debridement measurements of 3.2 cm x 2.4 cm x 0.2 cm. The right posterior distal buttocks wound also remained Stage 3 with pre-debridement measurements of 3.4 cm x 2.5 cm x 0.05 cm, and no post-debridement measurements were documented. Further review of wound care documentation dated 10/17/2025, 10/24/2025, and 10/31/2025 indicated that all previously identified wounds remained at the same stage and with no significant changes in measurements. Documentation dated 10/24/2025 additionally noted a new wound located on the left lateral third finger with a duration of one week and measurements of 0.4 cm x 0.4 cm x 0.1 cm. 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 Based on observation, LPA observed a repositioning chart posted in Resident 1’s room, which served as a reminder for staff regarding scheduled repositioning needs for R1. The Department interviewed the responsible party for R1, who stated they did not have any concerns regarding the allegations listed above. The Department also interviewed Witness 1, who stated they had no concerns regarding staff repositioning of Resident 1 or the cleaning and care of the resident’s wounds. Based on the information gathered, interviews, and record reviews, there is not enough evidence to support that Regency Palms Long Beach failed to provide proper care to Resident 1 resulting in pressure injures for 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. Allegation: Staff do not assist resident with obtaining medical care It was alleged that the resident teeth are rotting and the reporting party doesn't know if R1's is getting dental care. On 11/04/2025, between the hours of 11:25am - 11:45am , LPA interviewed Administrator (A1) regarding the allegation. A1 denied the allegation. A1 stated that depending on the resident's care plan, prompting and/or assistance is provided two times per day, as tolerated, for how often residents' teeth are brushed throughout the day. As it pertains to R1, the facility swabs their teeth, as the resident cannot safely swallow and is an aspiration risk. Additionally, R1's teeth show signs of decay consistent with her age and previous dental care. A1 stated the facility does not coordinate dental care for R1, as this matter is managed by the family. A1 also mentioned that at this point of R1's disease process, the resident could not receive dental care, as they could not get a dentist and R1 would not be able to survive the procedures. R1 is currently on hospice at the end of life, and comfort care is being administered per her Power of Attorney (POA). Report continues on LIC 9099-C 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 On 11/04/2025, between the hours of 8:42am - 12:20pm, LPA interviewed 7 staff members regarding the allegation. 7 of 7 staff denied the allegation and stated the residents' teeth are brushed every shift in the morning/evening and after every meal. On 11/04/2025, between the hours of 9:09am - 10:47pm, LPA interviewed 6 resident interviews regarding the allegation. 6 of 6 residents denied the allegation and stated staff do not assist with brushing their teeth, as the residents independently brush their own teeth. 2 of 6 residents said they have not had any dental procedures conducted. 2 of 6 residents stated their family and/or friends assist with their dental care needs. 1 of 6 residents stated they wish to go to the dentist since they have not been to the dentist while living at the facility.1 of 6 residents stated they went to the dentist three months ago. On 12/22/2025 between the hours of 3:00pm - 4:30pm, LPA conducted a records review of R1's Service Plan (dated 07/25/2025) on page 2 of 8 which states under the dental section full assistance with oral care On 10/28/2025 at 2:45pm, the department interviewed the responsible party for R1 who stated arranging for a mobile dentist to visit since R1 who is bed bound. The responsible party for R1 also stated visiting the facility daily to ensure her teeth are brushed properly. Although R1's responsible party did express concerns via email with staff regard frequency of R1's teeth being brushed based on the information gathered, interviews, and record reviews, there is not enough evidence to support that Regency Palms Long Beach failed to provide proper care to Resident 1 in regards to teeth rotting for 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. Exit interview conducted with Robert Jakini (Administrator) and a copy of this report was provided

It is being alleges that the facility staff are not bathing resident in care according to care plan. On 10/24/25 from 8:15am- 9:30 am Interviews were conducted with S1-S9 regarding the allegation above. 9 of the 9 staff interviewed denied the allegation above, 6 of 9 staff stated that residents have baths 2-3 times a week, 3 of 9 staff stated residents have bathes according to their care plan. 9 of 9 staff interviewed stated that when a resident refuses to bathe, it is documented on facility notes. On 10/24/25 from 9:30 am- 12:00 pm interviews were conducted with R2-R8 regarding the allegation above. 3 of the 7 residents interviewed denied the allegation above, 4 of the 7 residents interviewed reported they do not require assistance with bathing. 7 of 7 residents reported they have not gone more than 2 days without bathing. On 11/04/25 LPA conducted a review of the facilities shower schedule as well as a review of R1's Preplacement appraisal dated: 02/20/2024, Service plan dated:07/29/2025, and Physicians report dated:04/23/2025. Per shower log, R1 is schedules to shower 3 times a week. Per Preplacement appraisal dated: 02/20/2024 R1 requires partial assistance with bathing, although R1 prefers to do so on R1's own. Per Service plan dated:07/29/2025, R1 requires assistance with bathing 3 times a week as scheduled. Additionally, service plans states R1 requires heavy reminders and encouragement's to shower, and female staff only is required. Physicians report dated:04/23/2025, R1 is unable to bathe self. On 11/04/25 LPA reviewed facility notes dated 07/09/25 and dated 07/20/25. Notes dated 07/09/25 R1 was observed shaking and out of her norm, staff did not feel comfortable providing shower due to shaking, family was informed that R1 would not be receiving shower. Notes dated 07/20/25 facility notes indicated R1 was shaking shaking while being showered and lost balance but did not experience a fall, family was notified that R1 would not have a shower in the evening. On 11/04/25 LPA attempted to interview R1, however R1 did not wish to be interviewed. Allegation: Staff lock resident out of their bedrooms. It is being alleged that facility staff lock all the doors from the outside of the residents bedrooms in the memory care wing . On 10/24/25 from 8:15am- 9:30 am Interviews were conducted with S1-S9 regarding the allegation above. 9 of the 9 staff interviewed denied the allegation above, 2 of the 9 staff interviewed stated that residents have locked their bedroom doors as it is their right to do so. On 10/24/25 from 9:30 am - 12:00 pm interviews were conducted with R2-R8 regarding the allegation above. 7 of 7 residents interviewed denied the allegation above, and reported having access to bedrooms at all times. On 11/04/25 LPA attempted to interview R1, however R1 did not wish to be interviewed. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated. Exit interview conducted, and a copy of this report was provided.

The investigation revealed the following At 9:35 AM , LPA attempted to interview R1, who was not willing to engage in a conversation. LPA observed R1 with a purple thermos. R1’s personal companion opened the thermos, which was filled with water, and no mold was observed. At 9:45AM, LPA conducted interviews with staff members (S1–S7) and 7 out of 7 staff members stated that staff ensure residents’ cups are cleaned and sanitized daily throughout the day. Staff reported that residents typically receive water in their personal bottles or cups. Juices are served in facility- provided clear cups, which are cleaned after each use. When asked if mold had ever been seen in any residents’ personal cups, 7 out of 7 staff members stated they had not observed mold in any cups. When asked if residents are allowed to drink from their own personal cups, 7 out of 7 staff members stated yes, and that personal cups are also cleaned and sanitized daily. LPA Allen interviewed Witness (W1), who stated they heard about R1’s personal cup having mold but did not personally observe any mold during the week of 10/20/2025 through 10/24/2025. W1 stated R1 normally drinks orange-colored Pedialyte in their personal cup. When asked if staff clean and sanitize the cup, W1 responded yes. LPA also interviewed residents R1–R7 and 7 out 7 residents stated they have not had mold in their personal cups or in cups provided by staff. When asked if staff clean their personal cups, 7 out of 7 residents stated yes. Continued 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 Although the allegation suggests that staff do not ensure residents have sanitary drinking dishes, evidence gathered through observations, interviews with staff and residents, and a review of documentation did not support this claim. Therefore, based on interviews conducted, documents reviewed, and observations made, 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 violation did or did not occur. An exit interview was conducted where this report was discussed and provided to Robert Jakini-Administrator, at conclusion of the visit with appeal rights. Robert Jakini authorized xxxx to sign the report

On 10/24/2025 at 8:35am, Licensing Program Analyst (LPA) Zina Brown conducted an unannounced Case Management - Incident visit at this facility.  LPA met with Robert Jakini (Administrator) and explained the purpose of the visit to conduct a health and safety check to follow up on a reported incident to the department on October 22, 2025 in regarding personal rights. The incident report is in regards to personal right for Resident 2 (R2). Between the hours of 8:45am - 8:50am, LPA conducted a tour of the Resident 1 (R1) and Resident (R2) shared bedroom with Staff 1 (S1). LPA requested and obtained LIC 602 Physician's Report for Residential Care Facility for the Elderly for both Resident (R1) and Resident (R2). Due to insufficient time LPA has decided additional time is needed to complete the investigation. Exit interview conducted with Robert Jakini (Administrator) and a copy of this report was provided.

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- 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 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 r ooms #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 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 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.

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). 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). 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 department was unable to interview R1, as R1 passed away. Furthermore, the department conducted a tour of the facility. The investigation revealed the following: For the a llegation: Staff did not provide adequate food service to residents in care. It is being alleged that the food is never cut up nor pureed for the residents that can’t manage a whole chicken breast or a sandwich they couldn’t hold. On 10/15/25, the department conducted interview with S2 and S16-S20. Of those interviewed, 6 out of 6 staff stated that residents are provided adequate food service based on their dietary needs or modified diets. 6 out of 6 staff stated there is enough caregivers to attend to residents during mealtimes. 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 they do not have a special diet, and they eat what they want. 6 out of 6 residents said that staff does cut up, and puree residents food. 6 out of 6 residents stated there is enough caregivers to attend to residents during mealtimes. During a review of records, the department observed two weeks of the facility menu. The menu offers a variety of meals throughout the day, such as breakfast, lunch, dinner, including protein, starch, vegetables, and fruits. A review the Staff Roster revealed that the facility has enough staff to meet the needs of the residents served. The department conducted a tour of the facility and observed residents consuming a balanced lunch, which included chicken noodle soup, with a side of fruit, juice, and water. The kitchen was inspected, during which the department observed a five-day supply of perishable food and a seven- day supply of nonperishable food items were noted. The kitchen appeared clean, and no health or safety concerns were observed during the visit. 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. 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 Allegation: Staff did not safeguard resident's personal items. It is being alleged that three sets of bedding and towels were purchased prior to a resident moving into the facility, yet there were never any towels, including hand towels to wipe their hands on, and only one sheet on the residents bed. On 10/15/25, the department conducted interview with S2 and S16-S20. Of those interviewed, 6 out of 6 staff denied the allegation. 6 out of 6 staff said they are not aware of a resident missing bedding and towels. 6 out of 6 staff said that the facility provides the residents with basic bedding necessities. On 10/15/25, the department interviewed R2-R7, and were unable to interview R1, as they passed away. Of those interviewed, 6 out of 6 residents said they haven’t had an issue with any of their belongings missing. 6 out of 6 residents said that the facility provides them with basic bedding necessities. During a review of records, the department observed that R1’s Resident Personal/Property and Valuables form (signed/dated: 04/27/23) was blank and had no personal items listed. 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. Allegation: Staff did not meet residents' incontinence needs. It is being alleged that there is a lack of changing incontinence at the facility. On 10/15/25, the department conducted interview with S2 and S16-S20. Of those interviewed, 6 out of 6 staff denied the allegation. 6 out of 6 staff stated that residents are checked on at least every two hour or as needed, and depending on their needs. 6 out of 6 staff said residents are not left in soiled briefs for an extended period of time. On 10/15/25, the department interviewed R2-R7, and were unable to interview R1, as they passed away. Of those interviewed, 6 out of 6 residents said they do not require any assistance with toileting. 6 out of 6 residents said that staff check on them frequently. 6 out of 6 residents said they have not observed a resident left in soiled briefs for an extended period of time. 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 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.

The investigation revealed the following: Allegation: Staff engaged in an argument with a family member in front of the resident. It was alleged that the Executive Director engaged in a continuation of an argument with a family member in front of residents. On 08/11/2025, LPA interviewed Administrator (A1) regarding the allegation. A1 denied the allegation. A1 stated in the common area of the facility, one of the residents’ family members entered wearing a body camera that recorded staff and residents, which is a violation of residents’ rights. On 08/11/2025 between the hours of 2:30pm – 3:50pm, and on 10/02/2025 between 10:00am – 2:12pm, LPA conducted interviews with 10 residents regarding the allegation. Ten (10) of ten (10) residents denied the allegation. All residents stated they did not hear or witness any arguments between staff and a family member on July 31, 2025. On 08/11/2025 between the hours of 2:15pm – 3:41pm, and on 10/02/2025 between 10:10am – 12:44pm, LPA conducted interviews with nine (9) staff members regarding the allegation. Three (3) of nine (9) staff denied the allegation, and six (6) of nine (9) staff were unaware of the incident. The six staff stated they did not recall or know of any incident occurring on July 31, 2025, while three were not on shift at the time of the incident. On 10/08/2025, LPA interviewed Witness 1 (W1) regarding the allegation. W1 stated that while in the great room with her mother, she heard a discussion involving differing opinions but did not hear any yelling or screaming. W1 stated she would have preferred that the discussion be held privately rather than in front of guests and residents. LPM Hammond interviewed Witness (W2) further stated that upon entering the facility with a body camera, Administrator (A1) observed W2, followed them throughout the building, and began yelling and screaming in front of residents and several family members, causing discomfort among both residents and their families. Report continues on LIC 9099-C 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 On 10/15/2025 between the hours 09:00am - 09:15am conducted a record review and observed the following documents: On 08/02/2025, the department received a LIC 625: Unusual Incident/Injury Report (dated 07/31/2025) which stated R1's family member approached A1 with a body camera in the dining room on the third floor of memory care unit. A1 asked R1's family member to cease from filming as A1 did not consent to being recorded as well as its against policy and violates the resident's person rights. A1 made an attempt to de-escalate the situation by disengaging and contacting the Department of Social Service (DSS): Community Care Licensing (CCL). 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. Allegation: Staff locked residents out of their rooms. It was alleged that there was a continuous practice of the facility locking residents out of their rooms. On 08/11/2025, LPA interviewed Administrator (A1) regarding the allegation. A1 denied the allegation and stated there were no circumstances in which residents were intentionally locked out of their rooms. On 08/11/2025 between the hours of 2:30 pm – 3:50 pm, and on 10/02/2025 between 10:00 am – 2:12 pm, LPA conducted interviews with 10 residents regarding the allegation. Ten (10) of ten (10) residents denied the allegation and stated they had never been locked out of their rooms by staff. On 08/11/2025 between the hours of 2:15 pm – 3:41 pm, and on 10/02/2025 between 10:10am– 12:44 pm, LPA conducted interviews with nine (9) staff regarding the allegation. Seven (7) of nine (9) staff denied the allegation, and two (2) did not confirm or deny it. The seven staff stated they were never instructed to lock residents out of their rooms, while the two were not present at the time of the alleged incident. 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. Report continues on LIC 9099-C 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 Allegation: Due to lack of supervision, a resident defecated in the corner of the kitchen. It was alleged that due to a lack of supervision, a resident was searching for a bathroom and ultimately defecated in the corner of the kitchen. On 08/11/2025, LPA interviewed Administrator (A1) regarding the allegation. A1 denied the allegation. A1 stated that the resident had an accident in the kitchen and was unaware of how to manage it. Two of the staff were present and redirected the resident to her room, assisted with cleaning and changing, and then returned her to the common area. A1 explained that such incidents are common in memory care and are not typically reported to licensing, as they are part of the disease process. A1 also stated there are no cameras in memory care or assisted living common areas, only in certain resident rooms. On 08/11/2025 between the hours of 2:30pm – 3:50pm, and on 10/02/2025 between 10:00 am – 2:12pm, LPA conducted interviews with 10 residents regarding the allegation. Ten (10) of ten (10) residents denied the allegation and stated they had not witnessed or heard about a resident defecating in the kitchen area. On 08/11/2025 between the hours of 2:15pm – 3:41pm, and on 10/02/2025 between 10:10am – 12:44pm, LPA conducted interviews with nine (9) staff regarding the allegation. Nine (9) of nine (9) staff were unaware of the allegation and stated they did not witness or have knowledge of a resident defecating in the kitchen area. On 10/15/2025 between the hours of 9:20 am - 9:30 am, LPA conducted a record review and observed the following documents: LIC 602 Physician’s Report for Residential Care Facilities for the Elderly (RCFE), Resident Assessment, and Community Logs for Resident 2 (R2), which show no history of bowel incontinence or incidents of defecation. 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. Report continues on LIC 9099-C 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 An exit interview was conducted with Robert Jakini, Administrator, and a copy of this report was provided.

The investigation revealed the following: Allegation : Staff are smoking marijuana while working at the facility It was alleged that staff returned to the facility from their lunch break blowing smoke from a vape smelling like marijuana. On 09/17/2025 at 9:10 am, LPA interviewed A1. A1 who denied allegation stated two (2) staff members of the team confront the S10 and checked for any signs of impairment consistent with the use of marijuana or alcohol. S10 was also made to empty all of the contents of her pockets. No signs of intoxication were noted by either of the two (2) team members that addressed and interviewed R10. A1 states the the facility do not conduct random drug test. Between 9:18am - 2:17pm, LPA interviewed 10 staff regarding the allegation: 9 out 10 staff denied the allegation. 1 out 10 staff denied staff smoking on the facility premises, however some of the staff do smoke away from the facility grounds while on their break. Of the 9 staff who denied the allegation stated, not witnessing staff smoking nor smelling of marijuana upon returning from their breaks. Between 9:46am - 11:35am, LPA interviewed 7 residents: 7 out of 7 residents denied the allegation. Of the 7 residents who denied the allegation stated, not noticing any unusual smells like marijuana upon staff returning from being outside on their breaks. Between the hours of 1:00pm - 2:00pm, LPA reviewed records and observed the following: 10.1 Drug and Alcohol Policy - Being under the influence of alcohol, illegal drugs (as classified under federal, state, or local laws), or other impairing substance while on the job may post a serious health and safety risk to others and will not be tolerated. Prohibited Conduct: Regency Palms prohibits employees from engaging in the following activities when they are on duty or company business or on company premises (whether or not they are working): The use abuse or being under the influence of alcohol, illegal drugs or other impairing substances. While the use of marijuana has been legalized under some state laws for medicinal and/or recreational use, it remains an illegal drug under federal law. Regency Palms doesn't discriminate against employees solely on the basis of their lawful off-duty use of marijuana. You may not consume or be under the influence of marijuana while on duty or at work. If you have a valid prescription for medical marijuana, refer to the Company's Disability Accommodation policy for additional information. Based on interviews conducted an records reviewed there is no evidence to support the allegation, therefore the allegation is UNSUBSTANTIATED. 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 Allegation : Staff are rough and rude with residents It was alleged that staff was being rough and rude to a resident. On 09/17/2025 at 9:10 am, LPA interviewed A1. A1 who denied allegation and stated if in the event of staff being rough and rude a body integrity check is conducted on the alleged victim. The facility would interview the perpetrator and take appropriate action to address the complaint such as reporting it to the ombudsman and LPA and removing the offender from the workplace pending investigation. Between 9:18am - 2:17pm, LPA interviewed 10 staff the regarding the allegation: 10 out 10 staff denied the allegation. Of the10 staff who denied the allegation stated the staff stated they have not witnessed other staff members being rough nor rude towards the residents. The staff stated being polite and respectful while providing safe daily care to the residents. Between 9:46am - 11:35am, LPA interviewed 7 residents: 7 out of 7 residents denied the allegation. Of the 7 residents who denied the allegation stated feeling safe and respect when staff take care of the residents. Also, the residents stated they have not experienced themselves being handled rough and being treated rudely by the staff nor have not witnessed any of the staff being rough and rude with other residents. Between the hours of 1:00pm - 2:00pm, LPA reviewed records and observed the following: For R1 progress notes, there is no evidence of staff being rough and rude to resident . Based on interviews conducted an records reviewed there is no evidence to support the allegation, therefore the allegation is UNSUBSTANTIATED. 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 Robert Jakini (Executive Director) and a copy of the report was provided.

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 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 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 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 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). 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.

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). All 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. LPA specifically inquired about Resident 1 (R1) and whether R1 was provided dinner on August 23, 2025 . All 9 staff members expressed confidence that dinner was provided to R1; however, none could confirm whether R1 actually consumed the meal. Staff Members 3 and 4 (S3–S4), who have worked directly with R1 but were not on duty on August 23, 2025, during the PM shift, reported that R1 has a history of refusing meals. They stated that after three (3) attempts to encourage eating, a meal replacement such as Ensure is typically offered. At 12:00 PM , LPA interviewed Residents 1- 7 (R1–R7). 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. LPA attempted to interview R1 on three separate occasions; however, R1 was asle ep each time. At 1:10 PM , LPA reviewed end-of-shift notes from the AM shift dated August 21, 22, 23, 29, and September 2, 2025 . These notes indicated that R1 refused meals on each of those dates. However, a meal replacement was offered, and both the med tech and hospice nurse were informed of R1’s refusal to eat. When LPA requested PM shift notes specifically for dinner on those same dates, the facility was unable to provide them. continued 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 LPA also interviewed Witness 1 (W1) , who reported that R1 was not provided a meal but approximately two hours after dinner was served to other residents typically around 5:00 PM. W1 stated that this appeared to be an isolated oversight, though it was concerning. W1 added that R1 was eventually given a peanut butter and jelly sandwich and tuna salad. 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). 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 or excessive weight loss. 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 through 9 (S1–S9). All staff stated that residents are encouraged to drink water daily and hourly. During the facility tour, staff pointed out water stations available to residents on floors 4, 5, and 6. At 12:00 PM, LPA interviewed Residents 1 through 7 (R1–R7). Six out of seven residents confirmed they are provided meals daily, including beverages such as water and juice, and that staff encourage them to drink water every hour throughout the day. LPA again attempted to interview R1 on three separate occasions, but R1 was asleep each time. Continued 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 On September 4, 2025, at 9:15 AM, LPA made another attempt to interview R1. However, R1 was unable to stay on topic or engage in a coherent conversation. Despite this, LPA observed R1 being assisted by S4 while consuming oatmeal, water, and a bottled Starbucks Vanilla Frappuccino (cold brew). 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 confirmed that R1 was provided water on those dates. Additionally, LPA directly observed R1 drinking water during the visit. 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 violation did or did not occur. An exit interview was conducted where this report was discussed and provided to Robert Jakini- Administrator at conclusion of the visit.

Allegation: Signal System was made inaccessible to a resident in care The allegation alleges the string from a resident’s emergency pull cord had been cut and tied tightly around the button and that it was not able to be pulled. During the facility tour, LPA checked and tested the emergency pull cords in the following rooms 204A, 302B, 403A, 501A, 602A, 705, 805, and in a common area on the 7 th floor. LPA observed the tested emergency pull cord stations were operational, and staff responded to each call within 7 minutes. During record review, LPA received and reviewed the Pull Cord Stations testing log dated 06/11/2025, that is conducted by S3 on a monthly basis. The log had no indication that the emergency pull cord station in the room in question was not working properly. LPA did observe room 203s pull cords were not operating properly and was repaired the same day it was tested. Additionally, LPA received and reviewed the Work Orders for the facility and observed on 07/30/2025, a work order was submitted for room 302B by S7 at the request of S3 for the need of a bed pull cord. During interviews with Staff S1-S7, were asked if residents emergency pull cords are operational, seven (7) out of seven (7), stated residents emergency pull cords in their rooms and restrooms are operational. During interviews with Residents R2-R8, were asked if their emergency pull cord in their room is functional, seven (7) out of seven (7) stated yes, their emergency pull cords are operational. Additionally, Residents R2-R8, were asked if there have been any issues with their emergency pull cord or their pendants, seven (7) out of seven (7) stated there have been no issues with their pendants. During the course of the investigation, LPA was unable to find evidence to support the allegation. Although the allegation may have happened or is valid, there is no preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated . During today’s visit, LPA did not observe or cite any deficiencies. An exit interview was conducted with Executive Director, Robert Jankini, and a copy of this report was provided.

Continued LIC9099-C page 2 Facility Complaint and Grievance Policy (dated 08/23/2024) and Staff In-Service Training (dated 06/18/2024). On 07/24/2025, from 11:00 a.m. to 3:30 p.m., the Department interviewed staff members (S1-S3) and residents (R1-R2) regarding the complaint allegations. The Department also attempted to interview residents (R3-R7); however, they were non-verbal, spoke only limited words, and were unable to respond to any of the questions. Mr. Jakina and LPA Bunker toured the facility Memory Care Unit to observe and identify any signs of neglect, abuse, or other immediate health and safety threats. We did not observe any signs of neglect or abuse during today's visit. Investigation revealed the following. Allegation: Staff did not put a plan in place to ensure the resident would not be physically attacked by another resident It was alleged that the staff failed to put a plan in place to ensure the resident would not be physically attacked. On 07/24/2025, from 11:00 a.m. to 3:30 p.m., staff #1-3 (S1-S3) were interviewed and stated that the facility does have a dementia care plan in place, which was reviewed by the Department. S1 also confirmed that the facility enforces a zero-tolerance policy for negative behaviors, including physical aggression, and that house rules are in effect. 3 out of 3 staff members stated that residents sign an admission agreement acknowledging that physical aggression towards another resident is not permitted. 3 out of 3 staff members stated this was the first incident of aggressive behavior between the residents involved. 3 out of 3 staff members noted that the facility has a plan in place to ensure the residents are protected from being physically attacked by other residents. 3 out of 3 staff members stated that incidents between residents still may occur and that staff cannot prevent such incidents from happening. S1 stated on 07/21/2025, the facility self-reported the unusual incident report to Community Care Licensing and the Ombudsman office in a timely manner. On the same day, the Department received and reviewed the Unusual Incident Report. On 07/24/2025, from 11:00 a.m. to 3:30 p.m., Interviews were conducted with resident #1-2 (R1-R2), who stated that no physical attack occurred and denied the allegations. Resident #3-7 (R3-R7) were non-verbal, spoke only limited words, and were unable to answer any of the questions. See continued LIC9099-C page 3 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 Continued LIC9099-C page 3 Based on interviews, available evidence, observation, information received, and records reviewed there was not enough sufficient 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 deemed unsubstantiated. Investigation Revealed the following Allegation: Staff did not intervene during a resident-on-resident attack On 07/24/2025, from 11:00 a.m. to 3:30 p.m., staff #1-3 (S1-S3) were interviewed and stated that on 07/21/2025, there was an altercation between two residents; however, neither resident was injured. The caregivers intervened, and the staff self-reported the incident within a couple of hours to Community Care Licensing and the Ombudsman's office on that same day. The residents' responsible parties were also contacted immediately. The department received an Unusual Incident Report dated 07/21/2025 regarding the complaint allegation. S1-S3 stated that staff are trained and receive ongoing training to help prevent incidents like this from occurring. On 07/24/2025, the Department requested and reviewed the Staff In-Service Training on Preventing, Recognizing, and Reporting Abuse dated 06/18/2024. 3 out of 3 staff members stated that appropriate precautions were taken by staff intervening, separating the residents, and redirecting them. S1-S3 confirmed that this was the resident's first instance of aggressive behavior between the residents involved. On 07/24/2025, from 11:00 a.m. to 3:30 p.m., Interviews were conducted with resident #1-2 (R1-R2), who stated that no physical attack occurred and denied the allegations. Resident #3-7 (R3-R7) were non-verbal, spoke only limited words, and were unable to answer any of the questions. Based on interviews, available evidence, observation, information received, and records reviewed there was not enough sufficient 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 deemed unsubstantiated. There were no deficiencies cited. A copy of the Complaint Investigation Report LIC9099 and LIC9099-Cs was provided to Robert Jakina, Executive Director. An exit interview conducted

On 07/14/2025 at 3:10pm, Licensing Program Analyst (LPA) Zina Brown conducted an unannounced case management - deficiencies visit and met with Robert Jakini (Administrator) and explained the purpose of the visit. On 06/19/2025, the Department received an complaint # 11-AS-20250619142057 of which two (2) of the allegations were SUBSTANTIATED. On 07/14/2025, civil penalties were assessed for the deficiencies cited on 07/10/2025 for complaint #11-AS-20250619142057 under the California Code of Regulation Title 22, Division 6, Chapter 8. See attached LIC 9099-D. An exit interview was conducted with Robert Jakini, Administrator and a copy of this report was provided with appeal rights.

Allegation: Staff did not safeguard resident’s personal belongings The allegation alleges the facility staff lost a resident's belonging. During record review, LPA received and reviewed the facility’s House Rules, signed and dated by R1’s Responsible Party on 08/23/2024, that states under Administration Department number 7. Management is not responsible for lost or stolen items (refer to Theft and Loss Policy included in the Resident Paperwork). LPA received and reviewed Theft and Loss Policy, signed and dated by R1’s Responsible Party on 08/23/2024, that states “Residents are encouraged to complete a personal property inventory when they move-in. We ask residents to keep this form updated as items are removed or added to the apartment.” Additionally, the Theft and Loss Policy states “Management is not responsible for the loss or theft of valuable from your apartment.” LPA received and reviewed Resident Personal Property and Valuables (LIC621), signed and dated by R1’s Responsible Party on 08/24/2024, declining to track personal property for R1. LPA received and reviewed the Health and Safety Code Section 1569.152, 1569.153, and 1569.154 Residential Care Facilities for the Elderly form, signed and dated by R1’s Responsible Party on 08/24/2025, that states in Sec. 3 Section 1569.153 of the Health and Safety Code “(d) …The facility shall not be liable for items which have not been requested to be included in the inventory or for items which have been deleted from the inventory.” During interviews with Staff S1-S11, were asked if they were made aware of R1 having a bedrail, eleven (11) out of eleven (11) stated yes they were aware R1 had a bedrail brought in. Additionally, Staff S1-S11 were asked if the family requested to have the bedrail added to the Resident Personal Property and Valuables (LIC621) form, eleven (11) out of eleven (11) stated to their knowledge the bedrail was not requested to be included on the form. During interviews with Residents R1-R8, were asked if they had any personal items go missing, seven (7) out of eight (8) stated they have had no items missing and if they did have an item missing caregivers help to locate the item During the course of the investigation, LPA was unable to find evidence to support the allegation. Although the allegation may have happened or is valid, there is no preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated . During today's visit, LPA did not observe or cite any deficiencies. An exit interview was conducted with Regional Director, Lisa To, and a copy of this report was provided.

Investigation Revealed the Following: Allegation: Facility staff failed to reassess resident properly The details of the complaint alleged that facility staff failed to reassess (R#1) properly. On July 1, 2025, at approximately 10:00 AM, during a records review, LPA Iniguez observed that (R#1) had a copy of their Physician's Report for the Residential Care Facilities for the Elderly (RCFE), specifically the LIC 602A form, dated June 17, 2025. Additionally, LPA Iniguez found that the LIC 602A form was completed and signed by (R#1)'s primary care physician (W#1), not by (S#1). In contrast, (S#1) completed the service plan for (R#1) dated April 23, 2025, but it was not signed by (R#1)’s Power of Attorney (POA). On July 1, 2025, at approximately 2:00 PM, during interviews with facility staff (S#1), she stated that she did not complete (R#1)’s medical assessment or LIC 602A. Additionally, (S#1) stated that she only completed (R#1)’s care plan for the facility. During this investigation, LPA did not find sufficient evident to support the above-mentioned allegation(s). Based on the evidence gathered, interviews conducted, and records reviewed, the preponderance of evidence standard has been met; therefore, the above-mentioned allegation(s) are found to be UNSUBSTANTIATED. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur. An exit interview was conducted, and a copy of the Complaint Report was given to Monique Avila/Wellness Director.

During interviews LPA observed staff and residents to be wearing face mask. On 06/4/25 from 12:55pm-1:45pm. On 06/4/25 from 12:55pm-1:45pm LPA conducted a records review. The investigation revealed the following: Allegation: Staff are not taking universal precautions to ensure COVID is not spread. It is being alleged that Covid protocols are not being followed. On 06/04/24 from 10:15am- 11:22am LPA conducted interviews with R2-R7 regarding the allegation above, 6 of 7 residents interviewed denied the allegation above, per 6 of 7 residents interviewed reported being informed of positive covid cases and have been tested daily. On 06/04/25 and 06/13/25 LPA conducted interviews with S1-S5 regarding the allegation above, 5 of 5 staff interviewed denied the allegation above and reported that staff and residents are tested daily, staff received infection control training, and that families and Primary Care Physicians were made aware of covid positive cases via email. On 06/4/25 from 12:55pm-1:45pm LPA conducted a records review, during the records review, LPA observed the Facility’s Residential infection control plan and the Emergency and disaster plan for residential care facilities for the elderly; both plans are current and updated. LPA observed guidelines regarding how to prevent infection by COVID-19. In addition, LPA reviewed the In-services conducted on topics including, Universal precautions for infection control, COVID-19 plan, COVID-19 testing sites and kits, Use of PPE (Personal Protective Equipment) when handling COVID-19-positive residents, and PPE. LPA confirmed and observed unusual incident reports dated 06/03/25 were sent from facility to CCLD reporting the Covid- 19 positive staff and residents, LPA observed emails dated 05/28/25, 05/30/25, and 06/02/25 that were sent out to residents, families and friends notifying them and providing them of covid cases and updates, and documented communication between facility and the Long Beach Health Department dated 05/30/25 and 06/03/25. LPA observed staff and residents wearing mask while at the facility during visits. On 06/25/25 LPA conducted a tour of the facility and observed sanitation stations, and cleaning taking place. On 06/25/25 LPA was unable to interview R1 as R1 was sleeping at the time of visit. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated. Exit interview conducted, and a copy of this report was provided.

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.

INVESTIGATION REVEALED THE FOLLOWING: Allegation #1: Staff retaliated against resident resulting in eviction. The complaint alleges that the facility staff retaliated against a resident, leading to an eviction. Reports indicate that Regency Palms attempted to evict Resident #1 (R1) in a classic retaliation case. It appears that the facility is using unspecified incidents, which are common among residents with Major Neurocognitive Disorder (NCD), as justification for removing (R1). The family representative for (R1) is part of the Family Council. The facility does not want to evict (R1); instead, it tries to stop the family's advocacy efforts. On May 23, 2025, between 09:30 AM and 10:50 AM, the Department interviewed staff members identified as Staff #1 through Staff #3 (S1-S3). Three (3) out of the three (3) staff members could not validate this allegation. (S1-S3) denied any retaliation. (S1-S3) are aware that the incidents involving (R1) are not used for retaliation to serve for an eviction. (S1-S3) stated that they denied having retaliation due to (R1)’s family representatives’ involvement with the Family Council for Regency Palms. (S1-S3) stated the family’s involvement with the Family Council held monthly. These council meetings are specifically for residents and family members, and no Regency Palms personnel or staff are ever involved in these meetings. (S1) is notified when the meeting is scheduled and will promote it by posting in public spaces where visitors congregate. (S2-S3) stated they are not privileged to discuss any topics at these meetings, minutes a written record of a meeting, or capture key discussions, decisions, and action items. On May 23, 2025, between 11:00 AM and 11:10 AM, the Department interviewed a resident member identified as Resident #1 (R1). (R1) uttered an appreciation for living at the facility, highlighting the staff's friendly demeanor, who have consistently treated (R1) with kindness and respect. (R1) confidently stated that there had been no experience of mistreatment during (R1)'s stay. Furthermore, (R1) expressed surprise when asked about any eviction notice, indicating a complete lack of awareness regarding such a matter. On May 23, 2025, between 9:50 AM and 10:12 AM, the Department interviewed a witness member identified as Witness #1 the power of attorney for (R1 ). (W1) reiterated incidents that occurred with (R1) at the facility and felt that these incidents were reasons for the eviction, and perhaps the family representative’s advocate for (R1) is a retaliation for the eviction served to (R1) in April 2025. (W1) stated that they did not have demonstrative evidence or written communications, including emails and text messages, related to providing as retaliation for the family’s involvement with the Family Council. (Evaluation Report continues LIC 9099-C) 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 After reviewing the Physician's Report LIC 602A for (R1) (dated 08/19/24 and 02/12/25), Facility Resident Assessment (dated 04/23/25) revealed with (R1) is diagnosed with (NCD). A review of the Resident Lease Agreement (dated 8/24/24) included Eviction, Family Council, House Rules, Complaint & Concerns, Complaint Grievance Policy procedures. Personal Rights LIC 603C (dated 08/24/24) acknowledged by (R1) with signature. 30 Day Notice of Termination of Residency Letter (dated 04/14/25), and Family Council Meetings and Follow-up Email Correspondences (dated 12/25/24, 02/12/25, 02/22/25, 04/08/25, 04/15/25 and 05/06/25) revealed no written action of retaliation. During the May 23, 2025, visit, the Department identified that the facility promotes the rights of its residents. To improve the environment, the facility posted the Resident Rights, Personal Rights, California Residential Care Facilities for the Elderly Complaint Poster, California Long Term Ombudsman Poster, and the Family Council Meeting Poster. Based on the information gathered, there is not enough evidence to support the allegation mentioned above. Allegation #2: Illegal Eviction. The complaint alleges that the facility issued an illegal eviction to Resident #1 (R1). It reported that the facility failed to issue a legal eviction because the notice was defective. The notice failed to state any of the five legal reasons for the eviction and failed to provide details required by Title 22 Regulations. On May 23, 2025, between 09:30 AM and 10:50 AM, the Department interviewed staff members identified as Staff #1 through Staff #3 (S1-S3). Three (3) out of the three (3) staff members confirmed that a 30-Day Notice of Termination of Residency Letter (dated 04/14/25) was issued to Resident #1 (R1) along with the family representative and Community Care Licensing (CCL). According to (S1-S3) this Eviction Notice has now been terminated as of May 19, 2025, and is no longer valid. On May 23, 2025, between 11:00 AM and 11:10 AM, the Department interviewed a resident member identified as Resident #1 (R1). (R1) asserted was completely unaware of any eviction notice that had been issued by the facility staff. On May 23, 2025, between 9:50 AM and 10:12 AM, the Department interviewed a witness member identified as Witness #1 (W1) the power of attorney for (R1 ). (W1) acknowledged a 30-Day Notice of Termination (dated 04/15/25) was received. (W1) addressed that the Notice of Termination dated April 14, 2025, has become invalid. (Evaluation Report continues LIC 9099-C) 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 A review of (R1)’s 30-Day Notice of Termination Letter (dated 04/15/25) and Fed Ex Receipt (dated 04/15/25) was sent to (R1), family representative and an email receipt to Community Care Licensing (CCL). Based on the information gathered, there is not enough evidence to support the allegation mentioned above. Based on the information collected from the facility inspection, observations, interviews, and records analysis, the Department found no evidence to support the above allegations. Although the allegations may have happened or are valid, but there is not a preponderance of the evidence to prove that the alleged violations occurred. Therefore, the allegations are Unsubstantiated . An exit interview conducted with Executive Director Fabiola Marciano and copies of the report provided.

Allegation : Questionable Death The details of the complaint alleged S1 wheeled R1 into R1 bed room and left R1 unsupervised for an extended amount of time while R1 had a safety belt attached to R1 wheelchair. During this time, R1 aspirated and died. The department conducted interviews with the Administrator (A1) and Staff #1-8. A-1 Carla Mariano confirmed that R#1 was left in a room unsupervised approximately 1.5 hours with her safety belt on and was found slumped over in her wheelchair unresponsive. 8 out of 8 staff confirmed the allegation occurred. The department conducted records review which revealed R1 was admitted to the facility on 9/4/2021 (Resident Assessment Form, dated 9/4/2021) with primary diagnoses which included hypertension, agitation, generalized muscle weakness, and dementia. R1 was dependent with all ADLs, except assistance with feeding. R1 had motor impairment/paralysis in which R1 was wheelchair bound and unable to maneuver without assistance. R1 required assistance with transfer to and from the bed. R1 was noted with fair physical health status (Physician’s Report, dated 12/14/2022). It was also noted resident had diagnosis of dysphagia (Physician’s Report dated 9/7/2021). Based on the department’s review of R1 record there was no documented evidence a care plan to address the use of safety belt on the wheelchair for R1. Also, there was no care plan to address when and how often resident should be monitored on the wheelchair with R1 safety belt fastened. Lastly, there was no care plan to address resident at risk for aspiration/choking due to diagnosis of dysphagia and or any interventions to prevent resident from injuries related to the use of safety belt. The department reviewed the Death Certificate (dated 2/14/2023) which indicated the immediate cause: Possible aspiration. Based on the interviews conducted and records reviewed S1 failed to properly supervise R1 resulting in the death of R1. Based on records review and interviews, the preponderance of evidence standard has been met; therefore, the allegation of “Questionable Death” is found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division 6, Chapter 8 are being cited on the attached LIC 9099D. 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 Regarding the Allegation: Staff did not ensure postural support was used as prescribed. This complaint alleged that staff did not follow doctor’s orders on use of R1 Postural Support (safety belt) which resulted in the resident sliding out of the wheelchair. The department conducted interviews with the Administrator (A1) and Staff #1-8. A1 confirmed the allegation and 8 out of 8 staff confirmed the allegation occurred.. The department received an Unusual Incident/Injury Report from Regency Palms at Long Beach (dated 1/7/2023), indicated: on 1/7/2023 at approx. 11:15 a.m., R1 was observed sliding out of her wheelchair. With no complaints of pain or discomfort. Staff monitored resident and adjust as needed in wheelchair if noted sliding. Records review indicate the following: R1 Physician’s Report (dated 09/27/2021) indicates the safety belt is to keep R1 from sliding or falling from R1's wheelchair. Based on interviews and records reviewed staffed failed to use the postural support as prescribed which resulted in R1 sliding out of her wheelchair. Based on records review and interviews, the preponderance of evidence standard has been met; therefore, the allegation of “Staff did not ensure postural support was used as prescribed.” is found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division 6, Chapter 8 are being cited on the attached LIC 9099D. An $500 immediate civil penalty assessed. At this time, an enhanced civil penalty determination is pending in reference to Health & Safety Code 1569.49(e) Serious Death. Exit interview conducted with Administrator and appeal rights provided. 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 Regarding the Allegation: Staff did not secure resident's medication It is alleged that the facility staff do not secure residents medication resulting in medication ( Atorvastatin ) being stolen in December 2022. On 8/30/23 at around 12:04pm The department interviewed Staff and residents. 5 of 5 residents denied they have not had any missing medications nor ever running out of medications. 4 of 4 Staff interviewed deny the allegation and state that medications is ordered from the pharmacy and delivered to the facility. The facility staff sign for medications and take to Medication Room where it is locked and secured. No medications has come up missing. The Department observed the medication Mars records for R1 from April 2022 to Jan 2023. Upon review of the medication record of R#1 ,The Department finds that medication was given to R#1 as prescribed by physician. Based upon this investigation, LPA finds that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is UNSUBSTANTIATED. Exit interview conducted with Administrator.

This report supersedes, report dated 04/23/2025 to add additional information and additional citations. On 05/08/2025 at 11:15am Licensing Program Analyst (LPA) Zina Brown conducted an unannounced Case Management visit to issue deficiencies found during complaint investigation 11-AS-20250417101102. LPA met with Executive Director, Fabiola Marciano and explained the purpose of the visit. On the following dates, 1/6/2025 and 4/18/2025, the department received video surveillance from a shared residents' room. The videos received were from various angles inside the shared residents' room. The video surveillance also has audio component. On 4/23/2025, LPA conducted an interview with Executive Director (ED) Fabiola Marciano and the ED stated she was aware of the video surveillance in resident rooms and confirmed that no consent forms are on file. The ED also confirmed Regency Palms did not submit to Community Licensing a waiver request for the use of video surveillance in resident rooms. LPA conducted a file review of Resident #1 (R1) – Resident #7 (R7). Review of the Admissions Agreement observed on page 6 under Miscellaneous, which states, "10.9 Due to the privacy of the residents, residents will not have nanny cams in their apartment." Report continues on LIC 809-C 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 Based on the interviews conducted and records reviewed, Regency Palms Long Beach violated residents' personal rights by allowing video surveillance in residents with shared rooms. Regency Palms Long Beach did not adhere to its Plan of Operation by allowing the use of video surveillance in the room of Resident #1 (R1) - Resident #7 (R7). Regency Palms Long Beach failed to comply with Title 22 Regulations and the Evaluator Manual section 2-5800 Guidance on using Video Surveillance. Deficiencies cited under California Code of Regulation Title 22 Division 6 Chapter 8 are being cited on the attached LIC 809-D. Exit interview conducted with Executive Director - Fabiola Marciano and copy of this report was provided with appeal rights.

Allegation: Staff did not assist resident with care needs in a timely manner. The allegation alleges staff did not assist a resident with putting bottoms on while they were in bed and was not assisted till early morning, hours later. During the facility inspection, LPA observed Caregivers assisting residents in care. LPA observed caregivers assisting residents to the restroom, assisting with incontinence, changing clothing due to spills or accidents, escorting, grooming, and bathing. During record review, LPA received and reviewed Resident R1’s Care Plan dated 10/05/2024, that indicates R1 requires complete assistance with choice of clothing, dressing, and undressing 2 times per day, every day. Resident is unable to self-perform dressing/undressing. Additionally, LPA received and reviewed R1’s 90-Day Assessment dated 10/05/2024 and a Regency Palms Long Beach General Questions Assessment dated 05/07/2025. Both documents indicate Resident R1 “Requires completed assistance with choice of clothing, dressing, and undressing 2 times daily at 7:00 AM and 7:00 PM. During interviews with Staff S1-S11, were asked if residents who require assistance are assisted in a timely manner, eleven (11) out of eleven (11) state residents are assisted in a timely manner. During interviews with Residents R1-R8, were asked if they receive assistance in a timely manner, five (5) out of eight (8) stated staff come right away to assist. Additionally, one (1) out of eight (8) residents stated today was the first time they had to wait for an extended period of time for assistance due to a low battery in the 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 pendant. During the course of the investigation, LPA was unable to find evidence to support the allegation. Although the allegation may have happened or is valid, there is no preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated . LPA did not observe or cite any deficiencies during today's visit. An exit interview was conducted with Executive Director, Fabiola Marciano, and a copy of this report was provided.

Regarding the allegation: Licensee initiated the eviction process in retaliation against the resident. It is being alleged that the client received an eviction letter on 04/15/25, to move out of the facility effective date of 05/14/25. On 04/23/25, between 11:00 am to 12:00 pm, LPA Records reviewed of resident #1 R1 indicated that on 04/01/25, the Wellness Director (WD) conducted a reassessment and a needs of service plan that concluded R1 needed a higher level of care and supervision. The Wellness Director indicated that the Power of Attorney (POA) and the family members were aware of the findings of the reassessment and scheduled to meet with the facility on 04/25/25. On 04/23/25, interviewed with the Executive Director, indicated that the facility does not feel they can meet the resident's R1 higher level of care needs; therefore, A 30-day Eviction Notice and supporting documents were faxed to Community Care Licensing on 04/15/25, following the California Code of Regulations, Title 22. Based on interviews and records reviewed, there was not sufficient 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. There were no deficiencies cited. An exit interview was conducted a copy of the report was provided to the Executive Director, Fabiola Marciano.

Allegation: Licensee does not maintain facility in good repair. The details of the complaint alleges the main elevator in the facility, the washer and dryer, and the refrigerator is currently not working. During LPA’s visit on 03/04/2025, LPA measured the following temperatures of the refrigerators and freezer on each floor, on the 8 th floor the temperatures were 38-degrees and -1-degrees, on the 7 th floor the temperatures were 35-degrees and 0-degrees, on the 6 th floor the temperatures were 40-degrees and -3-degrees, on the 5 th floor the temperatures were 34-degrees, and -4-degrees, on the 4 th floor the temperatures were 35-degrees and -1-degree, on the 3rd floor the temperatures were 36-degrees and -2-degrees, and on the 2 nd floor the temperatures were 36-degrees and -1-degree Fahrenheit. LPA observed both elevators operational, a technician from Lift Tech Elevator Services was at the facility to inspect a sound that was reported in the main elevator, and said it is fully functional and operational. During file review, LPA received and reviewed the RPLB Work Order Management and observed on 02/22/2025, a work order was submitted for the third (3 rd ) floor refrigerator that was not keeping cool and showing a temperature of 60-degrees Fahrenheit. LPA observed the status update of the work order was “Done.” LPA was notified the refrigerator was replaced with another. Additionally, The facility was unable to get the invoices for elevator maintenance and repairs from the main office, but the LPA was able to conduct an interview with the technician from elevator service company. 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 During the visit, LPA met with a technician from Lift Tech Elevator Service, who stated they come out monthly to conduct maintenance to the elevators. Additionally, the technician stated that there have been some instances that when the elevator has gone down they had to wait for parts before they could repair it. During interviews, on 03/04/2025 between 9AM and 2PM, with Staff S1-S8, were asked if there was anything not working properly in the facility, eight (8) out of eight (8) stated the elevator does go down, but is currently working, the washer and dryers work but the dryers take a while to dry items, and refrigerators are currently working. During interviews, on 03/04/2025 at 11AM till 1:30PM, with Residents R1-R6, were asked if there was anything in the facility that is currently not operational, four (4) out of six (6) stated the main elevator goes down once in a while and the water takes a long time to get warm. During the course of the investigation, LPA was unable to find evidence to support the allegation. Although the allegation may have happened or is valid, there is no preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated .