300603257-4-6-2023-22-AS-SSAS-CRMW2Y-20230508165506

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 300603257
Report Date: 04/06/2023
Date Signed: 04/06/2023 03:41:44 PM

Unfounded

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/30/2023 and conducted by Evaluator Celine DePerio

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20230330162351

FACILITY NAME:	REGENTS POINT		FACILITY NUMBER:	300603257
ADMINISTRATOR:	FORNEY, MELINDA M		FACILITY TYPE:	741
ADDRESS:	19191 HARVARD AVENUE		TELEPHONE:	(949) 854-9500
CITY:	IRVINE	STATE: CA	ZIP CODE:	92612
CAPACITY:	399	CENSUS: 343	DATE:	04/06/2023
		UNANNOUNCED	TIME BEGAN:	01:41 PM
MET WITH:	Facility Administrator-Ashley Croslin Nurse Manager- Sheila Weathers		TIME COMPLETED:	04:05 PM

ALLEGATION(S):

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Resident sustained an unwitnessed fall due to lack of supervision while in care.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Celine De Perio made an unannounced complaint visit to the facility to initiate the 10-day visit for the complaint received on 3/30/23 and to deliver the findings. LPA De Perio was greeted by health and wellness director/facility administrator (AD)- Ashley Croslin and Nurse Manager (NM)r- Sheila Weathers and stated the purpose of the visit.

For today's visit, there are a total of 343 residents in care of which 5 are on hospice. LPA De Perio conducted interviews with staff and residents, and reviewed and requested copies of the pertinent records.

SEE LIC9099-C

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Luz Adams	TELEPHONE: (714) 222-3812
LICENSING EVALUATOR NAME: Celine DePerio	TELEPHONE: 714-703-2854
LICENSING EVALUATOR SIGNATURE:	DATE: 04/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/06/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 22-AS-20230330162351

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION 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: 04/06/2023

NARRATIVE

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This department has investigated the complaint alleging that resident sustained an unwitnessed fall due to lack of supervision while in care.

LPA conducted a tour of the facility, reviewed records and conducted interviews.

During the tour, it was reported that the resident lives in the assisted living portion of the facility, but has temporarily moved to the skilled nursing portion to receive additional care such as rehabilitation and physical therapy.

LPA reviewed the following documents such as, but not limited to: the staff roster, staff schedule, resident roster, incident reports pertaining to the resident, hospital documents, resident's physician report, resident's needs and services plan, and resident's discharge paperwork. Per record review, it was noted that the facility contacted 911 immediately upon observing the resident on the floor.

LPA conducted a total of 8 interviews which consisted of staff and residents, of which all 8 of the interviews did not corroborate with the allegation. Per interviews, it was stated that the facility contacts paramedics when a resident has sustained a fall, regardless if the resident sustains an injury or not, and that the facility nurses conducts an assessment on the spot. 1 of the interviews conducted, specified that "there were a lot of medical people helping". 2 of the interviews conducted, disclosed that upon observing the resident on the floor, 1 staff stayed with the resident to ensure safety, while the other staff contacted 911 right away and gathered any relevant paperwork that may be needed.

Based on observations and review of documents obtained, we have found that the complaint was UNFOUNDED, meaning that the allegation was false, could not have happened and/or is without a reasonable basis.

For today's visit, no citations were issued.

An exit interview was conducted with AD Croslin and NM Weathers, and a copy of this report was provided to the facility.

SUPERVISOR'S NAME: Luz Adams	TELEPHONE: (714) 222-3812
LICENSING EVALUATOR NAME: Celine DePerio	TELEPHONE: 714-703-2854
LICENSING EVALUATOR SIGNATURE:	DATE: 04/06/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/06/2023

LIC9099 (FAS) - (06/04)

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