198603428-10-31-2022-28-AS-RORN-CMXPE9-20230110101445

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603428
Report Date: 10/31/2022
Date Signed: 10/31/2022 04:02:23 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
10/27/2022 and conducted by Evaluator Christine Wong

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20221027091629

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:	10/31/2022
		UNANNOUNCED	TIME BEGAN:	12:35 PM
MET WITH:	Nichole Greene		TIME COMPLETED:	04:30 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Facility staff restricting resident from receiving visitors

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst (LPA) Christine Wong conducted an initial 10 days complaint to address the above allegation. LPA met with receptionist Debbie Golden and explained the purpose of the visit. Shortly after, the Executive Director Nichole Greene arrived and assisted with the visit.

The investigation consisted of the following: LPA interviewed administrator, three staff (S1-S3) and ten residents (R1-R10) and obtained R1's documents include face sheet, admission agreement, physician report and POA documents and letter from R1.

The investigation revealed of the following: In regards to the allegation of "Facility staff restricting resident from receiving visitors" LPA interviewed residents and all denied the allegation and stated that facility staff never restricted their family members to visit them. LPA interviewed R1 and reported its R1's decision whom can come to R1's room or where to meet.
(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: 10/31/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/31/2022

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 28-AS-20221027091629

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: 10/31/2022

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

R1 does not feel safe with those visitors who come to R1's room and felt endangered for them alone. R1 also reported no one ever forced R1 to make those decision. LPA interviewed administrator and reported they just follow residents' wishes and desires and they did speak to R1 personally and ensure R1 was not influenced by someone. R1 also wrote a note to the front desk and let the facility staff know whom can visit with permission.

Based on statements gathered from interviews conducted with staff, and facility residents and LPA observations, there was not enough supportive evidence to concur with the reported 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 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: 10/31/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/31/2022

LIC9099 (FAS) - (06/04)

Page: 2 of 2