300603257-2-26-2024-22-AS-AORZ-D2VSQG-20240228130442

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 300603257
Report Date: 02/26/2024
Date Signed: 02/26/2024 03:19:56 PM

Unsubstantiated

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
12/01/2020 and conducted by Evaluator Andrea Mendivil

COMPLAINT CONTROL NUMBER: 22-AS-20201201090430

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: 296	DATE:	02/26/2024
		UNANNOUNCED	TIME BEGAN:	01:15 PM
MET WITH:	Sheila Weathers - Nurse Manager		TIME COMPLETED:	02:45 PM

ALLEGATION(S):

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Resident developed pressure injuries due to neglect
Resident sustained an injury due to an unwitnessed fall

INVESTIGATION FINDINGS:

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On this day, Licensing Program Analyst (LPA) Andrea Mendivil made an unannounced visit to deliver complaint findings. LPA was greeted and granted entry into the facility Nurse Manager Sheila Weathers and explained the reason for the visit.
The Department received a complaint on 12/01/2020 and the initial 10 day visit was conducted on 12/10/2020. LPA Mendivil conducted a follow up visit on 10/25/2023. LPA Mendivil obtained copies of documents including physicians report and medical records. Regarding the allegations Resident developed pressure injuries due to neglect and Resident sustained an injury due to an unwitnessed fall, the investigation revealed the following:
Based on medical records dated from 11/16/2020 to 11/28/2020 it was reported on 11/17/2020 that Resident 1 (R1) was diagnosed with a stage 1 wound on coccyx. Based on interviews with 4 out of 4 staff all indicated that R1 did not have any wounds and did not have a history of skin breakdown, when R1 was sent out to the hospital on 11/16/2020.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Alisa Ortiz	TELEPHONE: (714) 703-4084
LICENSING EVALUATOR NAME: Andrea Mendivil	TELEPHONE: 714-703-2738
LICENSING EVALUATOR SIGNATURE:	DATE: 02/26/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/26/2024

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-20201201090430

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: 02/26/2024

NARRATIVE

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Based on physician’s reported dated 11/20/2018 indicated that R1 is able to ambulate on their own. Per 4 out of 4 interviews with staff R1 was able to ambulate with a walker. Based on interviews with 4 out of 4 staff indicated R1 was able to ambulate quickly and needed to slow down to ensure safety, which staff would remind R1. Per interview with staff, staff indicated they would check on R1 every 2 hours and report any issues with supervisors.

Therefore, based on the preponderance of evidence through records reviewed and interviews the allegations Resident developed pressure injuries due to neglect and Resident sustained an injury due to an unwitnessed fall are determined to be UNSUBSTANTIATED, meaning that although the allegation may have happened or are valid, there is not a preponderance of evidence to prove that the alleged violation occurred. This agency has investigated this complaint.

No deficiencies cited.

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

SUPERVISOR'S NAME: Alisa Ortiz	TELEPHONE: (714) 703-4084
LICENSING EVALUATOR NAME: Andrea Mendivil	TELEPHONE: 714-703-2738
LICENSING EVALUATOR SIGNATURE:	DATE: 02/26/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/26/2024

LIC9099 (FAS) - (06/04)

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