197604266-9-10-2021-28-AS-WSHO-C6X5LL-20210916200319

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197604266
Report Date: 09/10/2021
Date Signed: 09/10/2021 12:55:05 PM

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
08/23/2019 and conducted by Evaluator Tony Vasallo

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20190823164606

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: 102	DATE:	09/10/2021
		UNANNOUNCED	TIME BEGAN:	10:08 AM
MET WITH:	Kevin Taliaferro, Executive Director		TIME COMPLETED:	01:05 PM

ALLEGATION(S):

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Resident was not allowed to return to facility until he signed paper agreeing to pay for services that are not needed.

INVESTIGATION FINDINGS:

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Licensing Program Analyst's (LPA's) Vasallo and Mora conducted a subsequent complaint visit to investigate the allegation listed above. LPA's met with Executive Director, Kevin Taliaferro and explained the reason for the visit. The initial complaint visit was conducted on 8/29/19 by LPA Rivas.

The investigation consisted of the following: LPA Rivas conducted interviews with the facility Wellness Director, Resident #1 (R1), R1's private caregiver, and additional facility residents. LPA Rivas also reviewed R1's file and medications. During today's visit, LPA's reviewed R1's file. Interviews were conducted with R1 and the Wellness Director and Executive Director.

The investigation revealed the following: R1 was interviewed and R1 indicated they had no issues with the facility handling their medication and had no issues with paying the medication management fee. R1 did not recall ever having an issue with staff handling the medication or being forced to sign documents. Continued on 9099C.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Wei Siew Ho	TELEPHONE: (323) 981-3969
LICENSING EVALUATOR NAME: Tony Vasallo	TELEPHONE: (323) 981-3977
LICENSING EVALUATOR SIGNATURE:	DATE: 09/10/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/10/2021

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-20190823164606

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: 09/10/2021

NARRATIVE

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R1's admission agreement from 2015 was reviewed. R1 declined medication management at that time. In May 2019, R1 returned from a hospital stay and the facility began to handle R1's medication and began charging the medication management fee. R1 had a new physician's report completed in September 2019. The physician's report indicates R1 is able to handle his/her own medication. R1's records show the facility stopped charging the medication management fee on 9/13/19. R1's record show that on 9/3/20, facility started charging again for medication management. R1 does not have any issues with paying the medication management fee and agrees staff should assist with the medication. Staff interviewed agree R1 needs medication management and indicated they have not heard of R1 having an issue with paying the additional fee.

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.

SUPERVISOR'S NAME: Wei Siew Ho	TELEPHONE: (323) 981-3969
LICENSING EVALUATOR NAME: Tony Vasallo	TELEPHONE: (323) 981-3977
LICENSING EVALUATOR SIGNATURE:	DATE: 09/10/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/10/2021

LIC9099 (FAS) - (06/04)

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