197607820-8-5-2021-28-AS-MVAO-C75QJR-20210923121311

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197607820
Report Date: 08/05/2021
Date Signed: 08/05/2021 02:46:33 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
06/18/2020 and conducted by Evaluator Nicol Wesley

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20200618083732

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: 59	DATE:	08/05/2021
		UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Brianna Goodlett		TIME COMPLETED:	03:15 PM

ALLEGATION(S):

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Lack of supervision resulting in resident sustained injury.
Facility did not report abuse of resident.
Facility did not document/report change in resident condition and provide appropriate assistance

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Nicol Wesley conducted an unannounced subsequent complaint investigation and met with Business Office Manager Brianna Goodlett to discuss the purpose for today's visit.

Investigation consisted of the following: During the initial visit on 06/11/2020, LPA Wesley requested a copy of the current staff roster, resident roster, and copies of specific documents. There were no interviews conducted with staff or residents during the telephonic visit on 06/11/2020. During the investigation, CDSS Investigator Peter Zertuche interviewed staff, interviewed residents, interviewed other parties, and obtained copies of medical records, and hospital records.

Regarding allegation: Lack of supervision resulting in resident sustained injury, Facility did not report abuse of resident, and Facility did not document/report change in resident condition and provide appropriate assistance. IB investigator Peter Zertuche indicated the facility reported the residents were involved in a romantic
Continued on LIC 9099C.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Rebecca Orendain	TELEPHONE: (323) 981-3961
LICENSING EVALUATOR NAME: Nicol Wesley	TELEPHONE: (323) 981-3975
LICENSING EVALUATOR SIGNATURE:	DATE: 08/05/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/05/2021

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-20200618083732

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: 08/05/2021

NARRATIVE

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relationship that both families were aware of and approved, which was confirmed by the victim's(R1) adult son. One staff member reported one previous incident where the R1 stated R2 grabbed them by their arm causing bruises, but the incident was not witnessed by any staff, but management completed an incident report that stated unknown bruising was reported. Other staff member reported no history of aggression or abuse. Facility management stated since R2 had no history of aggression, there was no concern for abuse. Surveillance showed R1 entered R2's room numerous times without distress and during the incident, staff members intervened immediately. Local police arrested R2 for domestic battery and the case is currently pending in court. Based on the information obtained showing the residents were involved in an approved relationship, R1 willingly entered R2's bedroom and there was no documentation or history of abuse by R2, as no one has ever witnessed R2 being abusive. The investigation also revealed that facility staff monitors, assess, and documents all residents activity and change in condition in their care plan. R1s responsible party was notified that R1 required additional care and recommended they be placed in memory care due to their behaviors, but there was resistance from R1s family due to the increase in costs, so the facility administrator and R1s family agreed to a one week trial period. It was also discovered that the incident involving R1 and R2 occurred after the facility Administrator recommended that R1 be transferred to Memory Care due to an increase in their behavior. The facility provided appropriate assistance in trying to obtain safe, and healthful care and supervision for R1. There is no sufficient evidence to support neglect, therefore the case is closed with unsubstantiated findings.

Based on CDSS Investigator Peter Zertuche observations and interviews which were conducted, along with record review(s), the preponderance of evidence standard has not been met, therefore the above allegation(s) is/are found to be Unsubstantiated.

SUPERVISOR'S NAME: Rebecca Orendain	TELEPHONE: (323) 981-3961
LICENSING EVALUATOR NAME: Nicol Wesley	TELEPHONE: (323) 981-3975
LICENSING EVALUATOR SIGNATURE:	DATE: 08/05/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/05/2021

LIC9099 (FAS) - (06/04)

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