<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 197607820
Report Date: 06/15/2022
Date Signed: 06/15/2022 03:04:16 PM

Substantiated


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
06/06/2022 and conducted by Evaluator Elizabeth Irra
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20220606112343
FACILITY NAME:REGENCY PARK ASTORIAFACILITY NUMBER:
197607820
ADMINISTRATOR:ANNABELLE ARGENALFACILITY TYPE:
740
ADDRESS:925 EAST VILLA STREETTELEPHONE:
(626) 796-4303
CITY:PASADENASTATE: CAZIP CODE:
91106
CAPACITY:220CENSUS: 72DATE:
06/15/2022
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:S-1 and S-2TIME COMPLETED:
03:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff are blocking doorways in the facility.
Staff are leaving residents unattended while in care.


INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Elizabeth Irra conducted the initial complaint visit to investigate the above allegations. LPA met with S-1 and S-2 and discussed the purpose of today's visit. Facility Administrator/S-5 arrived at approximately 11:15 A.M..

During this investigation, LPA obtained a copy of the Staff roster (with staff contact information) and Resident roster and a list of Residents that are considered fall risk. LPA interviewed Staff #1 through Staff #5 (S-1 through S-5), Resident #2 was interviewed. R-1 refused to be interviewed. LPA also reviewed R-1's file and obtained relevant documentation.

Refer to LIC 9099C for the continuation of this report.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Christine YeeTELEPHONE: (323) 981-3312
LICENSING EVALUATOR NAME: Elizabeth IrraTELEPHONE: (323) 981-3979
LICENSING EVALUATOR SIGNATURE:

DATE: 06/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/15/2022
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 6
Control Number 28-AS-20220606112343
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: 06/15/2022
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
Allegation: Staff are blocking doorways in the facility. During this investigation, LPA interviewed staff and residents. R-1 refused to be interviewed. Staff interviews revealed that on 06/04/22, the night shift staff placed large tree planters blocking the front doors to camouflage the door due to night homeless activity nearby the facility. Staff interviews corroborate this allegation.

Allegation: Staff are leaving residents unattended while in care. During this investigation, LPA interviewed staff and residents. R-1 refused to be interviewed. Staff interviews revealed that on 06/04/22, there were only (2) staff working on the night shift instead of (4) staff. Per staff interviews, there were (2) staff members that did not work as scheduled on 06/04/22 (front desk and medication technician) and coverage was not obtained. Per interviews, there is a front desk staff during the day and another from 12 A.M to 8 A.M.. Per interviews, on 06/04/22, R-2 called the local Fire Department for assistance on behalf of R-1. Per staff interviews, there was no front desk staff during the night shift (after 12 A.M.) on 06/04/22 and they learned that R-2 had called and allowed the local Fire Department have access to this building to assist R-1. Interviewed staff indicated they learned that the local Fire Department was inside this building when the local Fire Department personnel began calling staff through the front desk walkie talkie. Per staff interviews, the front desk staff is responsible to provide building access after business hours. Per R-2 interview, R-2 opened the front door for the local Fire Department. Per interviews, the local Fire Department attended to R-1 and searched for staff and staff were not nearby and were contacted by the local Fire Department via walkie talkie. nterviewed staff indicated they do not sleep during their shift. Interviews corroborate this allegation.

Based on interviews conducted and records reviewed, the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED.

Deficiencies cited under California Code of Regulations Title 22

Exit interview conducted, appeal rights and a copy of this report was provided to S-2
SUPERVISOR'S NAME: Christine YeeTELEPHONE: (323) 981-3312
LICENSING EVALUATOR NAME: Elizabeth IrraTELEPHONE: (323) 981-3979
LICENSING EVALUATOR SIGNATURE:

DATE: 06/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/15/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 6
Control Number 28-AS-20220606112343
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: 06/15/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/17/2022
Section Cited
CCR
87307(d)(6)
1
2
3
4
5
6
7
Personal Accommodations and Services: (d) The following space and safety provisions shall apply to all facilities: (6) All outdoor and indoor passageways and stairways shall be kept free of obstruction.

This standard is not met as evidence by:
1
2
3
4
5
6
7
Administrator to submit a written plan to ensure that all outdoor and indoor passageways and stairways will remain free of obstruction at all times. Plan is to be submitted to LPA Irra by POC due date.
8
9
10
11
12
13
14
Per staff interviews, the 06/04/2022 night shift staff placed large tree planters blocking the front facility door due to homeless activity outside this facility.


8
9
10
11
12
13
14
Type B
06/17/2022
Section Cited
CCR
87468.1(a)(2)
1
2
3
4
5
6
7
Personal Rights of Residents in All Facilities (a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: (2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment. This standard is not met as evidence by: Per interviews, there were (2) staff working on the night shift instead
1
2
3
4
5
6
7
Administrator to submit a written plan specifying how staff will provide a safe, healthful and comfortable accommodations to all residents.
8
9
10
11
12
13
14
of (4) staff and coverage was not obtained. R-2 called the local Fire Department for assistance on behalf of R-1. There was no front desk staff during the night shift on 06/04/22 and they learned that R-2 had called and allowed the local Fire Department have access to this building to assist R-1.
8
9
10
11
12
13
14
Administrator to also submit a written plan specifying how staff coverage will handled and how they will be working with their local Fire Department to have access to this facility.

Plans noted above to be submitted to LPA Irra by POC due date.
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: Christine YeeTELEPHONE: (323) 981-3312
LICENSING EVALUATOR NAME: Elizabeth IrraTELEPHONE: (323) 981-3979
LICENSING EVALUATOR SIGNATURE:

DATE: 06/15/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/15/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 6
Control Number 28-AS-20220606112343
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: 06/15/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/17/2022
Section Cited
CCR
87468.1(a)(2)
1
2
3
4
5
6
7
This is a continuation of: 87468.1 (a)(2). Interviewed staff indicated they learned that the local Fire Department was inside this building when the local Fire Department personnel began calling staff through the front desk walkie talkie. Per staff interviews, the front desk staff is responsible to provide building access after business hours.
1
2
3
4
5
6
7
Administrator to also submit a written plan specifying how staff coverage will handled and how they will be working with their local Fire Department to have access to this facility.

Plans noted above to be submitted to LPA Irra by POC due date.
8
9
10
11
12
13
14
8
9
10
11
12
13
14
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
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: Christine YeeTELEPHONE: (323) 981-3312
LICENSING EVALUATOR NAME: Elizabeth IrraTELEPHONE: (323) 981-3979
LICENSING EVALUATOR SIGNATURE:

DATE: 06/15/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/15/2022
LIC9099 (FAS) - (06/04)
Page: 4 of 6
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
06/06/2022 and conducted by Evaluator Elizabeth Irra
PUBLIC
COMPLAINT CONTROL NUMBER: 28-AS-20220606112343

FACILITY NAME:REGENCY PARK ASTORIAFACILITY NUMBER:
197607820
ADMINISTRATOR:ANNABELLE ARGENALFACILITY TYPE:
740
ADDRESS:925 EAST VILLA STREETTELEPHONE:
(626) 796-4303
CITY:PASADENASTATE: CAZIP CODE:
91106
CAPACITY:220CENSUS: 72DATE:
06/15/2022
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:S-1 and S-2TIME COMPLETED:
03:30 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Resident sustained a fall while in care.
Staff threatened a resident while in care.

INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Elizabeth Irra conducted the initial complaint visit to investigate the above allegations. LPA met with S-1 and discussed the purpose of today's visit. Facility Administrator/S-5 arrived at approximately 11:15 A.M..

During this investigation, LPA obtained a copy of the Staff roster (with staff contact information) and Resident roster and a list of Residents that are considered fall risk. LPA interviewed Staff #1 through Staff #5 (S-1 through S-5), Resident #2 was interviewed. R-1 refused to be interviewed. LPA also reviewed R-1's file and obtained relevant documentation.

Refer to LIC 9099C for the continuation of this report.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Christine YeeTELEPHONE: (323) 981-3312
LICENSING EVALUATOR NAME: Elizabeth IrraTELEPHONE: (323) 981-3979
LICENSING EVALUATOR SIGNATURE:

DATE: 06/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/15/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 5 of 6
Control Number 28-AS-20220606112343
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: 06/15/2022
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
Allegation: Resident sustained a fall while in care. During this investigation, LPA interviewed staff and residents. R-1 refused to be interviewed. Staff interviews revealed that on 06/04/22, the night shift staff did not witness any resident falls nor received any complaints/concerns about residents falling. Interviewed staff indicated that when the local Fire Department was on-site on 06/04/22, staff were just informed that R-1 needed incontinence care. Per interviews, R-1 did not require medical attention and remained in this facility. Per interviews, R-1 received incontinence care. Per R-2 interview, R-1 called R-2 on R-2's landline and informed R-2 that R-1 had fallen. R-2 did not witness R-1 falling nor observed R-1 to be on the floor. Per R-2, R-2 was not allowed into R-1's room by the local Fire Department personnel once inside R-1's room. Therefore, R-2 proceeded to return to R-2's room. Interviews do not corroborate this allegation.

Allegation: Staff threatened a resident while in care. During this investigation, LPA interviewed staff and residents. R-1 refused to be interviewed. Per staff interviews, staff do not threaten Residents. Per staff interviews, staff have not received any complaints nor concerns in regards to staff threatening residents. Resident interviews indicated residents are not threatened nor have they heard any residents indicating that staff have threatened them. Interviews do not corroborate this allegation.

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 allegation is UNSUBSTANTIATED.

Exit interview conducted, appeal rights and a copy of this report was provided to S-2
SUPERVISOR'S NAME: Christine YeeTELEPHONE: (323) 981-3312
LICENSING EVALUATOR NAME: Elizabeth IrraTELEPHONE: (323) 981-3979
LICENSING EVALUATOR SIGNATURE:

DATE: 06/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/15/2022
LIC9099 (FAS) - (06/04)
Page: 6 of 6