197607820-11-24-2020-28-AS-MVAO-BXFSBB-20210120124340

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197607820
Report Date: 11/24/2020
Date Signed: 11/24/2020 04:24:50 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
06/03/2020 and conducted by Evaluator Mary G Flores

COMPLAINT CONTROL NUMBER: 28-AS-20200603120112

FACILITY NAME:	REGENCY PARK ASTORIA		FACILITY NUMBER:	197607820
ADMINISTRATOR:	ANNABELLE ARGENAL		FACILITY TYPE:	740
ADDRESS:	925 EAST VILLA STREET		TELEPHONE:	(626) 796-4303
CITY:	PASADENA	STATE: CA	ZIP CODE:	91106
CAPACITY:	220	CENSUS: 73	DATE:	11/24/2020
		UNANNOUNCED	TIME BEGAN:	01:15 PM
MET WITH:	Brianna Goodlet - Assistant Administrator		TIME COMPLETED:	04:15 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Staff do not respond to residents alerts in a timely manner

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst (LPA) Mary Flores initiated a complaint investigation for the allegations listed above. Due to the situation surrounding the Coronavirus Disease 2019 (COVID-19), and to implement mitigation measures, today’s complaint investigation was conducted telephonically with Brianna Goodlett, Business Services Director, person in charge.

The investigation consisted of the following: On 7/11/20, LPA Flores conducted telephone interviews with the business service director, resident #1, #2, #3,#4,#5,#6 (R1,R2,R3,R4,R5,R6), Staff #1,#2,#3,#4,#5,#6,#7 (S1,S2,S3,S4,S5,S6,S7), and requested copies of Physician's Report, Needs and Service Plan, Emergency Information/Face Sheet, Care Notes, and Pendant Call Report for R1,R2,R3,R4,R5,R6 and in-service training for staff on Personal Rights, Pendant Call Procedures. On 7/20/20, LPA conducted a video call and tested alert system call with a resident. 9/10/20 LPA interviewed Lourdes Menchaca administrator.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Rebecca Orendain	TELEPHONE: (323) 981-3961
LICENSING EVALUATOR NAME: Mary G Flores	TELEPHONE: (323) 981-3965
LICENSING EVALUATOR SIGNATURE:	DATE: 11/24/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/24/2020

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

LIC9099 (FAS) - (06/04)

Page: 1 of 3

Control Number 28-AS-20200603120112

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 ASTORIA	FACILITY NUMBER: 197607820
	VISIT DATE: 11/24/2020

NARRATIVE

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 investigation revealed the following: During resident interviews, 1 out of 6 residents stated staff take less than 5 minutes to respond to alert calls. 2 out of 6 residents stated to not use the alert call system as they are independent. 3 out of 6 residents stated staff respond after 10 minutes, in occasions taking staff to respond up to 40 minutes after the alert system button has been pressed by the resident. During interviews with staff, 6 out of 7 staff stated that facility’s protocol is to respond within 10 minutes of alert system call, and staff respond to residents’ alerts within those 10 minutes. 1 out of 7 staff stated that caregivers respond to pendant calls “right away”. Interview with Business Service Coordinator revealed the following procedure to respond to any alert system calls; Once the resident presses the button in their room, the signal goes to the receptionist computer. Receptionist notifies caregiver via radio, and the notification becomes acknowledge in the computer system, upon arrival of caregiver to residents’ room caregiver then presses a different button on back of pendant to clear the call and it shows in the computer system. LPA reviewed alert system logs for a month for the dates between 5/11/2020 through 6/11/2020. After reviewing the logs LPA found that 4 out of 6 resident’s alert system logs show staff had taken more than 10 minutes to respond to a resident’s call. The average respond time for over 50 recorded responses was between 15 to 45 minutes. LPA reviewed residents’ physician reports and observed that 3 out of 6 residents need assistance with Self – Care; toileting, bathing, dressing, and other needs. On 7/20/20 LPA tested alert call system via video call with the assistance of a resident, at 11:07am caregiver responded in 6 minutes and at 12:42pm caregiver responded in 11 minutes. 9/10/20 LPA Flores spoke with administrator Lourdes Menchaca who stated pendant alert system is provided to the residents upon admission for emergencies or if they need assistance, residents however mostly used it for assistance.

Based on interviews with staff, residents, observations, and documents reviewed the preponderance of evidence standard has been met, therefore the above allegation(s) are found SUBSTANTIATED. California Code of Regulations Title 22, Division 6 and Chapter 8 are being cited on the attached LIC 9099D.

Exit interview conducted with Brianna Goodlet, Assistant Administrator via telephone. A copy of this report 9099, 9099C, and 9099D was email for signature.

SUPERVISOR'S NAME: Rebecca Orendain	TELEPHONE: (323) 981-3961
LICENSING EVALUATOR NAME: Mary G Flores	TELEPHONE: (323) 981-3965
LICENSING EVALUATOR SIGNATURE:	DATE: 11/24/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/24/2020

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 28-AS-20200603120112

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 ASTORIA	FACILITY NUMBER: 197607820
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 11/24/2020

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 11/25/2020 Section Cited CCR 87415(a)(3)	1 2 3 4 5 6 7	87415 Night Supervision;(a) The following persons providing night supervision... shall be familiar with the facility's planned...assist in caring for residents in the event of an emergency. (3) In facilities caring...and one employee shall be on call and capable of responding within ten minutes. This requirement is not met as evidence by:	1 2 3 4 5 6 7	Facility will provide in service training regarding responding timely to alert system alarm by 11/25/20.
	8 9 10 11 12 13 14	Based on file/salarm system review, staff didn't responded within 10 minutes after R#2 pressed the alarm call system at 10:39pm, caregiver cleared it at 11:37pm, the caregiver responded within 58.37minutes which poses an immediate Health, Safety, Personal rights risk to persons in care.	8 9 10 11 12 13 14
Type B 12/08/2020 Section Cited CCR 87101(c)(3)(A)	1 2 3 4 5 6 7	87101 Definition; (3) "Care and Supervision" ... involves assistance as needed with activities on... responsibility for the safety and well-being of residents.... (A) Assistance in dressing, grooming, bathing and other personal hygiene; This requirement is not met as evidence by:	1 2 3 4 5 6 7	Facility will provide in service training educating staff and residents regarding the use of the emergency call system by 12/08/2020.
	8 9 10 11 12 13 14	Based on iterviews and file/alarm system log review, facilty did not responded to the needs of the residents in a timely manner as 3 out 6 residents needed assistance with personal hygiene which poses a potential Health, Safety, or Personal Right, risk to persons in care.	8 9 10 11 12 13 14

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: Rebecca Orendain	TELEPHONE: (323) 981-3961
LICENSING EVALUATOR NAME: Mary G Flores	TELEPHONE: (323) 981-3965
LICENSING EVALUATOR SIGNATURE:	DATE: 11/24/2020

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/24/2020

LIC9099 (FAS) - (06/04)

Page: 3 of 3