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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 197607820
Report Date: 10/24/2022
Date Signed: 10/24/2022 03:16:35 PM


Document Has Been Signed on 10/24/2022 03:16 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		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 ASTORIAFACILITY NUMBER:
197607820
ADMINISTRATOR:ANNABELLE ARGENALFACILITY TYPE:
740
ADDRESS:925 EAST VILLA STREETTELEPHONE:
(626) 796-4303
CITY:PASADENASTATE: CAZIP CODE:
91106
CAPACITY:220CENSUS: 84DATE:
10/24/2022
TYPE OF VISIT:OfficeUNANNOUNCEDTIME BEGAN:
02:31 PM
MET WITH:Richard Kale - Executive VicePresident
Anabelle Argenal - Assistant Administrator 		TIME COMPLETED:
03:30 PM
NARRATIVE
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Licensing Program Analyst(s)(LPA) Mary Flores and Licensing Program Manager (LPM) Tony Vasallo conducted an informal office meeting with Annabelle Argenal Assistant Administrator, Brianna Goodlet Assistant Administrator, and Richard Kale Executive VicePresident.

During the office meeting the following was discussed:
  • LPM Vasallo reviewed facility's compliance for past substantiated complaints.
  • LPA Flores discussed Priority 1 complaint regarding allegation: Severe neglect resulting in resident developing stage 4 pressure injury to provide substantiated findings.
  • Facility's Preventive Plan is as follow per Brianna Goodlet Assistant Administrator:
Facility is to provide wound care and assessment training to staff.
Facility is to ensure a medical professional assess wound prior returning to the facility.
Facility staff is to contact 911 or taking residents to the Emergency room if necessary.

Exit interview was conducted with Anabelle Argenal Assistant Administrator and a copy of this report was provided.
SUPERVISOR'S NAME: Stefanie CoronelTELEPHONE: (323) 981-3961
LICENSING EVALUATOR NAME: Mary G FloresTELEPHONE: (323) 981-3965
LICENSING EVALUATOR SIGNATURE:
DATE: 10/24/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/24/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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