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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603428
Report Date: 03/20/2023
Date Signed: 03/29/2023 01:57:04 PM


Document Has Been Signed on 03/29/2023 01:57 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		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 COVINAFACILITY NUMBER:
198603428
ADMINISTRATOR:GREENE, NICHOLEFACILITY TYPE:
740
ADDRESS:150 SOUTH GRAND AVENUETELEPHONE:
(626) 332-3344
CITY:WEST COVINASTATE: CAZIP CODE:
91791
CAPACITY:160CENSUS: 98DATE:
03/20/2023
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME BEGAN:
11:45 AM
MET WITH:Nichole Greene TIME COMPLETED:
12:30 PM
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Licensing Program Analyst (LPA) Christine Wong conducted an Annual/Required visit by using the Compliance And Regulatory Enforcement Tools on 3/16/2023 but due to time restrains and LPA has returned on today's date 3/20/2023 to finish the remaining two (2) Domains LPA met with Receptionist Debbie Golden who allowed entry into the facility and shortly after, the administrator Nichole Greene arrived and assisted with the visit.

On today's date, LPA inspected the two domains include: Personnel Record Training and Residents with Special Health Needs.

Personnel Record-Training: Staff files are maintained at the facility. Staff have current CPR/first aid training and sufficient on-going training that meets the annual requirement.
Residents with Special Health Needs: The facility accepts and retains residents with dementia and/or hospice. The staff received training on appropriately caring for residents with dementia and those on hospice.

Today, LPA also interviewed 5 residents 4 staff during the annual inspection.

No deficiencies were observed today. An exit interview was held. A copy of this report were given to the Administrator Nichole Greene
SUPERVISOR'S NAME: David SicairosTELEPHONE: (323)980-4934
LICENSING EVALUATOR NAME: Christine WongTELEPHONE: (323) 981-3963
LICENSING EVALUATOR SIGNATURE:
DATE: 03/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/20/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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