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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 198602039
Report Date: 08/16/2021
Date Signed: 08/16/2021 01:15:13 PM

Unsubstantiated


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 DR #100
MONTEREY PARK, CA 91754
This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/13/2021 and conducted by Evaluator Jose Calderon
COMPLAINT CONTROL NUMBER: 11-AS-20210813144646
FACILITY NAME:REGENT VILLA RETIREMENT HOMEFACILITY NUMBER:
198602039
ADMINISTRATOR:GORDON, JENNIFACILITY TYPE:
740
ADDRESS:201 W WARDLOW RDTELEPHONE:
(562) 595-6529
CITY:LONG BEACHSTATE: CAZIP CODE:
90807
CAPACITY:188CENSUS: 132DATE:
08/16/2021
UNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:ADMINISTRATOR JENNI GORDONTIME COMPLETED:
02:00 PM
ALLEGATION(S):
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Facility did not safeguard resident's cash.
INVESTIGATION FINDINGS:
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On 08/16/2021 around 01:00 pm Licensing Program Analyst (LPA) Jose Calderon initiated a complaint investigation to deliver the investigation findings for the allegation listed above. Today’s complaint investigation was conducted face to face with Administrator Jenni Gordon.

The Investigation consisted of the following: On 08/16/2021 LPA Calderon interviewed Administrator Jenni Gordon and conducted a tour of the physical plant. LPA Calderon obtained copies of Staff and Resident rosters, Resident #1 and 2s record (Needs and Service Plan, Pre-Placement Appraisal, Physicians Report and any SIR reports for R1 or R2 for the past 6 months. On 08/16/2021 LPA Calderon interviewed staff S1regarding complaint and on 08/16/2021 LPA Calderon interviewed R1-R2 for complaint on 08/16/2021 LPA Calderon received and reviewed facility paperwork for R1 and R2.


Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Jose Calderon
LICENSING EVALUATOR SIGNATURE:

DATE: 08/16/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/16/2021
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 2
Control Number 11-AS-20210813144646
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 DR #100
MONTEREY PARK, CA 91754
FACILITY NAME: REGENT VILLA RETIREMENT HOME
FACILITY NUMBER: 198602039
VISIT DATE: 08/16/2021
NARRATIVE
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The investigation revealed the following:

Allegation: Facility did not safeguard resident's cash.
It is alleged on Facility did not safeguard resident's cash. On 08/13/2021 LPA Calderon interviewed witness to complaint W1 states that she spoke to R1 who made complaint to her regarding missing money but told W1 that R1 did not call the police or advise administrator for missing money. On 08/16/2021 LPA Calderon reviewed facility paperwork for R1 and R2: Reviewed physician report, needs and service plan, staff and resident rosters and could not find any mental issues for ether resident. On 08/16/2021 LPA Calderon interviewed S1 who confirmed that R1 nor R2 ever made a complaint for missing money, and nether resident had any complaints against them or had ever been accused of stealing money. S1 states they receive moneys from the federal government and family and keep the money in cash form for resident use. S1 states that they use LIC405 to keep track of resident’s money. On 08/16/2021 LPA Calderon interviewed R1-R2, both accused the other one of stealing money, neither called the police or informed administrator of the supposed missing money and neither has proof the other stole money.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is unsubstantiated.

A exit interview was conducted with Administrator Jenni Gordon, and a hard copy was provided.
SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Jose Calderon
LICENSING EVALUATOR SIGNATURE:

DATE: 08/16/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/16/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 2