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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 300603257
Report Date: 11/22/2022
Date Signed: 11/22/2022 02:58:33 PM


Document Has Been Signed on 11/22/2022 02:58 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: 251DATE:
11/22/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:34 PM
MET WITH:Nurse Manager-Melissa GoldmanTIME COMPLETED:
03:20 PM
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Licensing Program Analyst (LPA) Celine De Perio conducted an unannounced case management visit at facility to follow up on a report made via phone call from Director of Wellness, Ashley Croslin. LPA De Perio was greeted by Licensed Vocational Nurse/Nurse Manager (LVN) Melissa Goldman at the entrance of the facility. Director of Wellness (DW), Ashley Croslin was unable to be present during time of visit.

For today's visit, there are a total of 251 residents in care, of which 1 is on hospice.

On 11/8/22, DW Croslin contacted LPA De Perio and stated that there was a resident who claimed to have had her jewelry stolen. DW Croslin and LVN Goldman stated that per facility's protocol, "if belongings are being reported as stolen or missing, and if the value is over $25, then we call the police".

On 11/22/22, LPA De Perio interviewed LVN Goldman who stated that resident has been "recently diagnosed with Dementia, and claimed that her jewelry was stolen." LVN Goldman stated "when you walk into her closet, on the left hand side, there are just a bunch of towels, where the resident said she was hanging her gold jewelry. But when you look on the right hand side, there is actually a hanger that has all her gold jewelry-bracelets, necklaces, chains, you name it." LVN Goldman stated that her and DW Croslin conducted a "thorough inspection" of her belongings, and notified resident that police will need to be called. "When resident was notified that police needed to be called, she said "never mind, I changed my mind".
LVN Goldman stated "When police came out, the resident didn't want anything to do with the police and refused to talk to them. She refused wanting to file a report"

LVN Goldman stated that resident's daughter was also notified of the situation, and also refused to file a police report and thanked facility for exercising good effort regarding the incident.
SUPERVISOR'S NAME: Luz AdamsTELEPHONE: (714) 222-3812
LICENSING EVALUATOR NAME: Celine DePerioTELEPHONE: 714-703-2854
LICENSING EVALUATOR SIGNATURE:
DATE: 11/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/22/2022
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: REGENTS POINT
FACILITY NUMBER: 300603257
VISIT DATE: 11/22/2022
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LPA De Perio was unable to interview resident due to resident declining wanting to be interviewed.

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

LPA De Perio conducted an exit interview with LVN Goldman 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: 11/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/22/2022
LIC809 (FAS) - (06/04)
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