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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 015201935
Report Date: 12/11/2024
Date Signed: 12/11/2024 04:13:17 PM

Document Has Been Signed on 12/11/2024 04:13 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME:REGENT HOMEFACILITY NUMBER:
015201935
ADMINISTRATOR/
DIRECTOR:		SANGCO, KAREN L.FACILITY TYPE:
734
ADDRESS:2508 REGENT ROADTELEPHONE:
(925) 371-5274
CITY:LIVERMORESTATE: CAZIP CODE:
94550
CAPACITY: 5CENSUS: 4DATE:
12/11/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:25 PM
MET WITH:Karen Sangco, AdministratorTIME VISIT/
INSPECTION COMPLETED:
04:25 PM
NARRATIVE
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On 12/11/2024 at 2:25PM, Licensing Program Analyst (LPA) G. Luk arrived unannounced to conduct a case management visit in regards to incident report received on 11/19/2024. LPA met with Administrator, Karen Sangco and explained the purpose of the visit.

Incident report dated 11/19/2024 revealed that C1's medication (Lasix) was not given on 11/4/2024. Administrator observed C1's medication was still in the bubble pack, but documented as given in the MAR (Medication Administration Records). C1's doctor and family was notified.

During visit, LPA reviewed incident report, MAR, and training log. LPA observed that staff (S1) was given training on medication administration.


The deficiency was observed (see LIC 809D) and cited from the California Code of Regulation, Title 22. Failure to correct the deficiency may result in civil penalties.

Exit interview conducted. A copy of this report and appeal rights provided.
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Grace Luk
LICENSING EVALUATOR SIGNATURE: DATE: 12/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/11/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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Document Has Been Signed on 12/11/2024 04:13 PM - It Cannot Be Edited


Created By: Grace Luk On 12/11/2024 at 03:46 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612

FACILITY NAME: REGENT HOME
FACILITY NUMBER: 015201935

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/11/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
12/12/2024
Section Cited
CCR
80075(b)(5)(B)

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Health Related Services. Once ordered by the physician the medication is given according to the physician's directions. This requirement is not met as evidence by:
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Administrator conducted training for S1 on 11/18/2024 and LPA obtained a copy of the training document.
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Based on record review and interview, licensee did not comply with the section cited above by not administering medication according to physician's order which poses an immediate health and safety risk to the persons in care.
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Deficiency Cleared

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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Harpreet Humpal
LICENSING EVALUATOR NAME:Grace Luk
LICENSING EVALUATOR SIGNATURE:
DATE: 12/11/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/11/2024


LIC809 (FAS) - (06/04)
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