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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 300603257
Report Date: 03/07/2022
Date Signed: 03/07/2022 12:49:46 PM


Document Has Been Signed on 03/07/2022 12:49 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
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868



FACILITY NAME:REGENTS POINTFACILITY NUMBER:
300603257
ADMINISTRATOR:FORNEY, MELINDA MFACILITY TYPE:
741
ADDRESS:19191 HARVARD AVENUETELEPHONE:
(949) 854-9500
CITY:IRVINESTATE: CAZIP CODE:
92612
CAPACITY:399CENSUS: 287DATE:
03/07/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
12:21 PM
MET WITH:Melinda Forney and Ashley CroslinTIME COMPLETED:
01:15 PM
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Licensing Program Analyst (LPA) Kimberly Lyman conducted an unannounced case management visit to follow up on an incident report submitted to Community Care Licensing on 02/03/2022. LPA was allowed entry into the facility and met with Executive Director Melinda Forney.

Incident report dated 02/01/2022 indicated Resident 1's (R1) discontinued Lorazapam 0.5 was discovered to be empty. Per medication records there should have been 30 pills left. Medication was being stored in an area waiting for destruction. Facility looked for the medication and called Irvine Police Department who came out and took a report. Facility interviewed staff as well as a registry nurse who had been working at the facility. All interviewed denied any knowledge of the missing medication. Facility contacted registry and advised staff would no longer be working at the facility. Facility has changed their procedure for medications waiting for destruction and Nurse Manager is auditing the medications for error. Cash value of medication is $19.00. No further investigation needed.

Exit interview conducted and a copy of this report was left at the facility.

SUPERVISOR'S NAME: Alisa OrtizTELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Kimberly LymanTELEPHONE: (714) 795-1497
LICENSING EVALUATOR SIGNATURE:
DATE: 03/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/07/2022
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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