198603428-6-23-2025-28-AS-DSIS-DJ6PQF-20250701113101

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603428
Report Date: 06/23/2025
Date Signed: 06/23/2025 02:23:51 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 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
06/17/2025 and conducted by Evaluator Bennette Pena

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20250617164800

FACILITY NAME:	REGENCY GRAND AT WEST COVINA		FACILITY NUMBER:	198603428
ADMINISTRATOR:	MIMS-BURRIS, MARY		FACILITY TYPE:	740
ADDRESS:	150 SOUTH GRAND AVENUE		TELEPHONE:	(626) 332-3344
CITY:	WEST COVINA	STATE: CA	ZIP CODE:	91791
CAPACITY:	160	CENSUS: 118	DATE:	06/23/2025
		UNANNOUNCED	TIME BEGAN:	10:12 AM
MET WITH:	Mary Mims-Burris, Executive Director		TIME COMPLETED:	02:30 PM

ALLEGATION(S):

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Facility staff are not preventing resident from bullying other residents in care.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Bennette Pena conducted an unannounced initial complaint visit to investigate the above allegation. LPA met with Mary Mims-Burris, Executive Director and explained the purpose of the visit.

The investigation consisted of the following: LPA obtained copies of the staff & resident rosters, Staff in service training (Residents' Rights), House Rules, Resident #1 (R1) and Resident #2 (R2) pertinent files and Incident report. LPA interviewed Staff #1 (S1) - Staff #4 (S4), (S2 was telephonically interviewed at 12:57pm) and Resident #1 (R1) - Resident #12 (R12).

In regards to the allegation: “Facility staff are not preventing resident from bullying other residents in care.” It is alleged that on 06/12/2025, R1 was bullied by R2 who has been bullying residents and staff for months without consequence. (4) out of (4) staff interviewed denied the allegation. Staff interviewed stated that the facility conducts internal investigation and do corrective actions on problems immediately. Interview with Staff #1 (S1) revealed that they investigated the incident and spoke with Resident #1 (R1) and Resident #2 (R2) in order to discuss the matter. S1 believed the issue was resolved. ***CONTINUED ON LIC9099-C***

Unsubstantiated

Estimated Days of Completion:

NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Bennette Pena
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 06/23/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/23/2025

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 28-AS-20250617164800

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: REGENCY GRAND AT WEST COVINA	FACILITY NUMBER: 198603428
	VISIT DATE: 06/23/2025

NARRATIVE

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Furthermore, S1 checked on R1 the next day, who stated she was doing well. S1 indicated that R2 has been repeatedly reminded of the residents’ rights and the house rules. S1 met with R2 on 06/13/2025 at 2pm to address the issue and R2 was verbally warned that if the behavior continues in the future, R2 must move elsewhere. Today, both R1 and R2 were interviewed, and they believed the issue was resolved. (12) out of (12) residents interviewed feel safe and comfortable in the community. (11) of (12) residents interviewed denied being bullied by other residents. Additionally, residents stated that if they have issues, the staff are always available to talk to and act on resolving the issue right away. Documentation reviewed and interviews conducted do not corroborate this allegation.

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

Exit interview held and a copy of the report was provided to Mary Mims-Burris, Executive Director

NAME OF LICENSING PROGRAM MANAGER: David Sicairos
NAME OF LICENSING PROGRAM ANALYST: Bennette Pena
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 06/23/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/23/2025

LIC9099 (FAS) - (06/04)

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