198602039-12-22-2025-11-AS-JHAD-DPNRWE-20251224122301

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198602039
Report Date: 12/22/2025
Date Signed: 12/22/2025 10:16:30 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/25/2025 and conducted by Evaluator Lizeth Villegas

COMPLAINT CONTROL NUMBER: 11-AS-20250825155922

FACILITY NAME:	REGENT VILLA RETIREMENT HOME		FACILITY NUMBER:	198602039
ADMINISTRATOR:	GORDON, JENNI		FACILITY TYPE:	740
ADDRESS:	201 W WARDLOW RD		TELEPHONE:	(562) 595-6529
CITY:	LONG BEACH	STATE: CA	ZIP CODE:	90807
CAPACITY:	188	CENSUS: 145	DATE:	12/22/2025
		UNANNOUNCED	TIME BEGAN:	09:44 AM
MET WITH:	Assistant Administrator Karina Salomon		TIME COMPLETED:	10:30 AM

ALLEGATION(S):

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Staff did not prevent resident from punching another resident in care resulting in injuries.

INVESTIGATION FINDINGS:

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On 12/22/25, The Department conducted a subsequent complaint visit to deliver findings. The Department met with Assistant Administrator as the reason for the visit was explained.

The investigation consisted of the following:

On 08/26/25, The Department requested a copies of the following documents: staff roster (dated 8/17/25 ), resident roster (dated 8/23/25 ), and the following documents for residents #1-2 (R1-R2): R1 Resident Pre-placement Appraisals (dated 12/13/23,) R2 pre-placement appraisal (dated 3/2/23 R1's Incident reports (dated 8/25/25), R1 Physician's Report (dated 11/8/24), R2's Physician’s Report (dated 12/10/24), R1's Admission Agreement (dated12/13/23) and R2's admission agreement (dated 3/2/23). On 09/03/25 The Department conducted a subsequent visit and conducted interviews with S1 and Resident #3 (R3). On 09/03/25 The Department also obtained copies of the following for R1 and R2: Identification and emergency information, physicians orders and medication logs for July and August 2025.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Lizeth Villegas
LICENSING EVALUATOR SIGNATURE:	DATE: 12/22/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/22/2025

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 11-AS-20250825155922

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
EL SEGUNDO ASC, 400 CONTINENTAL BLVD, STE 340
EL SEGUNDO, CA 90245

FACILITY NAME: REGENT VILLA RETIREMENT HOME	FACILITY NUMBER: 198602039
	VISIT DATE: 12/22/2025

NARRATIVE

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On 09/12/25 The Department attempted to conduct an interview with R1, but were unsuccessful due to communication barrios. On 09/23/25 The Department conducted interview with witness #1 (W1), and on 10/02/25 The Department conducted interview with staff #2 (S2).

The investigation revealed the following:

Allegation: Staff did not prevent resident from punching another resident in care resulting in injuries

It is being alleged that a resident in care obtained an injury after being punched in the face by another resident. On 09/03/25 The Department conducted interview with S1 regarding the allegation above. S1 confirmed the allegation above, however S1 indicated that R1 and R2 had no prior disagreements leading to the incident. S1 also reported that R2 had no prior history of aggressive behaviors. 09/03/25 The Department conducted interview with R3 regarding the allegation above. R3 confirmed the allegation above, however, R3 report that facility staff arrived quickly to assist. On 09/12/25 The Department attempted to conduct an interview with R1 but were unsuccessful due to communication barrios. On 09/23/25 The Department conducted interview with witness #1 (W1) regarding the allegation above. W1 reported being aware of the incident between R1 and R2 and stated R2 has no history of aggression. On 10/02/25 The Department conducted interview with S2 regarding the allegation above. Per S2, S2 arrived at the dining room when the altercation ended. Additionally, S2 reports there were staff members present and had already intervened by the time S2 arrived. On 12/16/25 The Department conducted a review of R1 and R2 physician reports dated: 11/08/24 and 03/26/25, and R1 and R2 needs and individual service plans both date 2/21/25. Upon review it was observed that neither resident has a documented history of aggressive behaviors or altercations with residents nor staff.

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.

Exit interview conducted, and a copy of this report was provided to the Assistant Administrator.

SUPERVISORS NAME: Janae Hammond
LICENSING EVALUATOR NAME: Lizeth Villegas
LICENSING EVALUATOR SIGNATURE:	DATE: 12/22/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/22/2025

LIC9099 (FAS) - (06/04)

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