198603428-5-31-2022-28-AS-RORN-CJ8L67-20220913082812

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603428
Report Date: 05/31/2022
Date Signed: 05/31/2022 04:19:37 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 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
05/24/2022 and conducted by Evaluator Christine Wong

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20220524085436

FACILITY NAME:	REGENCY GRAND AT WEST COVINA		FACILITY NUMBER:	198603428
ADMINISTRATOR:	GREENE, NICHOLE		FACILITY TYPE:	740
ADDRESS:	150 SOUTH GRAND AVENUE		TELEPHONE:	(626) 332-3344
CITY:	WEST COVINA	STATE: CA	ZIP CODE:	91791
CAPACITY:	160	CENSUS: 102	DATE:	05/31/2022
		UNANNOUNCED	TIME BEGAN:	08:35 AM
MET WITH:	Nicole Greene		TIME COMPLETED:	04:50 PM

ALLEGATION(S):

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Staff did not observed resident's change of condition
Staff did not provide resident's medication information to attending professional
Staff mismanaged resident's medication
Staff did not provide resident's physicians orders
Staff did not assist resident with incontinence needs
Staff did not safeguard resident's personal items

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Christine Wong conducted an initial 10 days complaint investigation to address the above allegations. LPA met with receptionist Veronica Cordero and explained the reason of the visit. Shortly after the Wellness Director Debbie Galaviz and Executive Director Nicole Greene arrived and assisted with LPA's visit.

The investigation consisted of the following: LPA interviewed Executive Director, Wellness Director and five (5) staff and ten residents (R2-R11) and obtained copy of the documents included staff roster, resident roster, Resident#1 (R1)'s LIC 601, LIC603A, Admission Agreement, Physician Report (08/16/2021), Service Plan (06/12/21, 12/16/21, 02/17/22, 04/14/22) and Medication List of May, 2022.

The investigation revealed of the following: Allegation#1 "Staff did not observe resident's change of condition." LPA interviewed staff and reported R1 was doing well and did not complaint any pain before the date of having vomitting episode. (See LIC 9099C for continuation)

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Christine Yee	TELEPHONE: (323) 981-3978
LICENSING EVALUATOR NAME: Christine Wong	TELEPHONE: (323) 981-3963
LICENSING EVALUATOR SIGNATURE:	DATE: 05/31/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/31/2022

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-20220524085436

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 GRAND AT WEST COVINA	FACILITY NUMBER: 198603428
	VISIT DATE: 05/31/2022

NARRATIVE

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The staff did notify the family immediately and they had been monitored R1's condition. On the next day, the staff observed R1 had been vomiting for more than 24 hours, and notified resident became more unresponsive and shortness of breath and the oxygen and temperature level was low, staff decided to call 911 immediately and sent resident to hospital, the staff did follow the protocol. Based on LPA's interview conducted, the preponderance of evidence standard has been met, therefore the above allegation(s) are found UNSUBSTANTIATED.

Allegation#2 "Staff did not provide resident's medication information to attending professional" LPA interviewed staff and denied the allegation and reported the staff already prepared the emergency packet before they called 911, then handed the packet when the Paramedics arrived. And each resident's emergency packed is located at the reception office by resident's last name. According to the staff, the emergency packet is included resident's emergency face sheet, updated physician report , insurance card and medication list. The Executive Director also stated that this is part of the job duty for the front desk/receptionist to photocopy the emergency packet once they received the page/call from Med-tech or any nursing staff about calling the Paramedics. Based on LPA's interview conducted, documents reviewed and LPA's observation, the preponderance of evidence standard has been met, therefore the above allegation(s) are found UNSUBSTANTIATED.

Allegation#3 "Staff mismanaged resident's medication " LPA interviewed ten (10) residents and all residents denied staff mismanaged their medication. Staff always gave them the medication on the right time with a right dosage. LPA interviewed staff and all denied the allegation and reported all med-tech received training for medication and no resident ever complained staff mismanaged their medication. Based on LPA's interview with residents and staff, documents reviewed and LPA's observation, the preponderance of evidence standard has been met, therefore the above allegation(s) are found UNSUBSTANTIATED.

Allegation#4 "Staff did not provide resident's physicians orders" LPA interviewed staff and denied the allegation and stated that R1's family never asked the physician order or R1's medication list from the facility. R1's family only requested R1's left over medication and the facility did provide it back to the family with the release form. Based on LPA's interviews, the preponderance of evidence standard has been met, therefore the above allegation(s) are found UNSUBSTANTIATED.

SUPERVISOR'S NAME: Christine Yee	TELEPHONE: (323) 981-3978
LICENSING EVALUATOR NAME: Christine Wong	TELEPHONE: (323) 981-3963
LICENSING EVALUATOR SIGNATURE:	DATE: 05/31/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/31/2022

LIC9099 (FAS) - (06/04)

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Control Number 28-AS-20220524085436

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 GRAND AT WEST COVINA	FACILITY NUMBER: 198603428
	VISIT DATE: 05/31/2022

NARRATIVE

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Allegation#5 "Staff did not assist resident with incontinence needs" LPA interviewed residents and denied the allegation and reported staff took good care of them. They never had to wait for a long period of time for staff to change their diaper and staff would come and check on them regularly. Resident also reported they never had any skin issues due to soiled diaper. LPA interviewed staff and denied the allegation and reported caregiver would have six minutes once they get the call light from the residents or caregiver would let other caregivers know if they need help or cannot get into the residents on time. Based on LPA's interviews with staff and residents, the preponderance of evidence standard has been met, therefore the above allegation(s) are found UNSUBSTANTIATED.

Allegation#6 "Staff did not safeguard resident's personal items" LPA interviewed ten (10) residents and three out of ten residents reported they did lost something in the facility, but all residents reported they feel safe living in the facility and staff are very helpful and always available if they need any assistance. Staff reported no resident ever complained that they lost anything in the facility. For R1, she was in charge of her own hearing aids and she can put it on by herself. When R1 lost her hearing aid, the staff did try to locate it for R1 but they could not find it. Therefore, R1 was missing one hearing aid. Based on LPA's interviews with staff and residents, the preponderance of evidence standard has been met, therefore the above allegation(s) are found UNSUBSTANTIATED.

Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove
the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED.

Exit interview was conducted with Executive Director Nicole Greene and a copy of this report was provided.

SUPERVISOR'S NAME: Christine Yee	TELEPHONE: (323) 981-3978
LICENSING EVALUATOR NAME: Christine Wong	TELEPHONE: (323) 981-3963
LICENSING EVALUATOR SIGNATURE:	DATE: 05/31/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/31/2022

LIC9099 (FAS) - (06/04)

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