197607820-6-29-2021-28-AS-SCOL-CCRMSG-20220322095149

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197607820
Report Date: 06/29/2021
Date Signed: 06/29/2021 01:32:13 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
06/25/2021 and conducted by Evaluator Mary G Flores

COMPLAINT CONTROL NUMBER: 28-AS-20210625104126

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: 56	DATE:	06/29/2021
		UNANNOUNCED	TIME BEGAN:	09:08 AM
MET WITH:	Marisela Soria - Wellness Coordinator		TIME COMPLETED:	01:45 PM

ALLEGATION(S):

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Facility staff does not adequately supervise resident.
Facility does not provide a safe environment for resident.

INVESTIGATION FINDINGS:

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Licensing Program Analyst(s) (LPA)Mary Flores conducted an unannounced complaint investigation visit regarding the above allegation(s). LPA Flores met with Marisela Soria, Wellness coordinator and explained the reason of the visit. Assistant administrator Brianna Goodlet arrived an hour later.

The investigation consisted of the following: LPA Flores conducted a tour of residents' rooms randomly choosen, room #134,151,200, 203,244, interviewed residents #1(R1),#2(R2),#3(R3),#4(R4),#5(R5),#6(R6),#7(R7) and staff #1(S1),#2(S2),#3(S3),#4(S4),#5(S5),#6(S6), interview resident #7(R7) over the phone and requested copies of R1,R2,R3,R4,R5,R6 identification and emergency information, physician's report, apprailsal/needs and service plan, and medication sheet.

The investigation revealed the following: Regarding allegation; facility staff does not adequately supervise residents. It is alleged resident wanders the facility banging on residents doors. During interviews with residents, 4 out of 7 residents interview stated not to have heard or observed residents in hallways disturbing or banging on doors. 2 out 7 residents were unable to be interview due to cognitive skills. 1 out of 7 residents stated there is a resident who has knocked at her door twice looking for spouse. (CONTINUED ON LIC 9099C)

Unsubstantiated

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: 06/29/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/29/2021

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-20210625104126

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: 06/29/2021

NARRATIVE

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During interviews with staff, 2 out of 6 staff stated there is a resident in independent living who recently has shown a change in condition in the last few weeks, who is currently being monitored by staff and physician and has a follow up appointment scheduled on 7/1/21. 3 out of 6 staff interview stated to not be aware or heard of residents being disruptive in the independent living side. 1 out of 6 staff stated a resident knocked at other resident's door once looking for spouse but there was no disruptive or dangerous behavior observed. Documents reviewed revealed residents have a current physician report conducted within the last year and a current or updated appraisal/needs an service plan reviewed within the last 8 months and facility is currently monitoring residents change in condition or following up with needs. Based on LPA's interviews and document review conducted the preponderance of evidence standard has been met, therefore the above allegation(s) are found UNSUBSTANTIATED.

Regarding allegation: Facility does not provide a safe environment for resident. It is alleged resident has dementia and is residing in the general housing section of the facility instead of the memory care unit. During interviews with residents, 4 out of 7 residents interview stated not to have heard or observed residents in hallways disturbing or banging on doors, and feel good about living at the facility. 2 out of 7 residents stated facility staff responds to residents needs. 2 out 7 residents were unable to be interview due to cognitive skills. During interviews with staff, 2 out of 6 staff stated there is a resident in independent living who recently has shown a change of condition in the last few weeks who is currently being monitored by staff and physician and has a follow up appointment scheduled, however behavior is not harmful towards other residents or self. 3 out of 6 staff interview stated to not be aware or heard of residents being disruptive. Administrator stated there is a total of 4 caregivers and 2 med tech during day shift. Wellness coordinator stated any resident living the facility must sign out before leaving facility with receptionist on lobby. During resident's rooms tour LPA tested R1's call button and staff responded within 3 minutes. Documents reviewed revealed 2 residents have a primary diagnosis of dementia and both residents currently reside in the memory care unit. Based on LPA's interviews and document review conducted the preponderance of evidence standard has been met, therefore the allegation is 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, therefore the allegations are UNSUBSTANTIATED.
Exit interview was conducted with Assistant Administrator Brianna Goodlet and a copy of this report was provided.

SUPERVISOR'S NAME: Rebecca Orendain	TELEPHONE: (323) 981-3961
LICENSING EVALUATOR NAME: Mary G Flores	TELEPHONE: (323) 981-3965
LICENSING EVALUATOR SIGNATURE:	DATE: 06/29/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/29/2021

LIC9099 (FAS) - (06/04)

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