197604266-9-18-2020-28-AS-FFIS-BZ9TF9-20210319144109

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197604266
Report Date: 09/18/2020
Date Signed: 09/18/2020 10:53:57 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

This is an official report of an unannounced visit/investigation of a complaint received in our office on
12/11/2019 and conducted by Evaluator Kruz Long

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20191211152833

FACILITY NAME:	REGENCY PARK FAIR OAKS		FACILITY NUMBER:	197604266
ADMINISTRATOR:	SUSAN SNYDER		FACILITY TYPE:	740
ADDRESS:	951 S. FAIR OAKS AVE.		TELEPHONE:	(626) 799-9906
CITY:	PASADENA	STATE: CA	ZIP CODE:	91105
CAPACITY:	310	CENSUS: 105	DATE:	09/18/2020
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Annabelle Argenal		TIME COMPLETED:	11:00 AM

ALLEGATION(S):

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Staff forged personal checks of residents.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Kruz Long delivered complaint findings for the allegation listed above. Due to the situation surrounding the Coronavirus Disease (COVID-19), and to implement mitigation measures, today's complaint findings delivery was conducted telephonically with Annabelle Argenal (Administrator).

During the initial site visit on 12/20/19, LPA obtained a copy of Resident roster, and interviewed Staff #1 in the conference room at 9:20 am. Interview with Staff #1 indicate that Resident #1 and Resident #2 does not reside in the facility and have never resided in the facility. Resident roster does not contain the names of Resident #1 and #2.

During the subsequent site visit on 01/15/20, LPA interviewed Staff #2 in the conference room at 11:45 pm. Obtained/reviewed copies of Staff #3's records, interviewed Residents #3 and #4 between 12:17 pm to 1:05 pm in the conference room, interviewed Resident #5 in the bedroom at 2:01 pm, interviewed Resident #6 in the gym at 2:16 pm and interviewed Resident #7 in the bedroom at 2:25 pm. Continue to LIC9099C.....

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Fernando Fierros	TELEPHONE: (323) 981- 3981
LICENSING EVALUATOR NAME: Kruz Long	TELEPHONE: (323) 383-8117
LICENSING EVALUATOR SIGNATURE:	DATE: 09/18/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/18/2020

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

LIC9099 (FAS) - (06/04)

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Control Number 28-AS-20191211152833

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: REGENCY PARK FAIR OAKS	FACILITY NUMBER: 197604266
	VISIT DATE: 09/18/2020

NARRATIVE

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5 out of 5 residents interviewed stated they were never victims of financial abuse in the facility. Alleged victims of check forgery doe not live in the facility nor have they ever reside in the facility.

Based on LPA's record review and interviews, investigation revealed: 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.

A telephonic exit interview was conducted with Annabelle Argenal and a hard copy was provided via email for signature.

SUPERVISOR'S NAME: Fernando Fierros	TELEPHONE: (323) 981- 3981
LICENSING EVALUATOR NAME: Kruz Long	TELEPHONE: (323) 383-8117
LICENSING EVALUATOR SIGNATURE:	DATE: 09/18/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/18/2020

LIC9099 (FAS) - (06/04)

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