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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 300603257
Report Date: 10/06/2022
Date Signed: 10/06/2022 04:16:39 PM


Document Has Been Signed on 10/06/2022 04:16 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: 290DATE:
10/06/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
02:45 PM
MET WITH:Director of Wellness-Ashley CroslinTIME COMPLETED:
04:32 PM
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Licensing Program Analyst (LPA) Celine De Perio conducted an unannounced case management visit at facility to follow up on the incident report (SIR) for resident #1 (R1) that occurred on 9/29/22 of which the Regional Office received on and 10/3/22. LPA De Perio was greeted and granted entry by Director of Wellness Ashley Croslin, Nurse Manager Melissa Goldman, and Executive Director Melinda Forney. For today's visit, there are a total of 290 residents in care.

LPA De Perio conducted a tour of the interior and exterior portion of the facility with Nurse Manager. LPA De Perio reviewed R1's file and obtained pertinent copies of chart. LPA De Perio toured R1's room and conducted an interview with R1.

For today's visit, no deficiency was noted for areas observed. No citation was issued.

LPA De Perio conducted an exit interview with Director of Wellness, Nurse Manager, and Executive Director and a copy of this report was provided to the facility.

SUPERVISOR'S NAME: Luz AdamsTELEPHONE: (714) 222-3812
LICENSING EVALUATOR NAME: Celine DePerioTELEPHONE: 714-703-2854
LICENSING EVALUATOR SIGNATURE:
DATE: 10/06/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/06/2022
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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