306005350-3-29-2021-22-AS-AORZ-C2CW4T-20210423165804

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306005350
Report Date: 03/29/2021
Date Signed: 03/29/2021 12:58:52 PM

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
02/18/2020 and conducted by Evaluator Ruth Martinez

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20200218160802

FACILITY NAME:	REGENCY, THE		FACILITY NUMBER:	306005350
ADMINISTRATOR:	DEBORAH BROWN		FACILITY TYPE:	740
ADDRESS:	24441 CALLE SONORA		TELEPHONE:	(949) 830-8057
CITY:	LAGUNA WOODS	STATE: CA	ZIP CODE:	92637
CAPACITY:	220	CENSUS: 91	DATE:	03/29/2021
		UNANNOUNCED	TIME BEGAN:	12:25 PM
MET WITH:	Heidi Charette		TIME COMPLETED:	01:00 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

-Facility does not have adequate staffing to meet the needs of the residents

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst (LPA) Ruth Martinez contacted the facility via tele-visit due to COVID-19 precautionary measures to deliver findings for the investigation into the above identified complaint allegation. LPA spoke with Heidi Charette, Administrator and explained the purpose of the telephone call.

During the course of the investigation the following was conducted interviews with the following: multiple staff and residents. A review of the following: staff rooster, resident rooster, resident files, wanderguard activity reports, wanderguard maintenance report, progress notes, menus, theft and loss records, resident evaluation reports, and MAR records.

It is alleged that facility does not have adequate staffing to meet he needs of the residents. The investigation revealed the following: upon review of staff rooster indicates that facility has a total of 19 caregivers hired at the

CONTINUED ON LIC9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Marina Stanic	TELEPHONE: (714) 703-2851
LICENSING EVALUATOR NAME: Ruth Martinez	TELEPHONE: (657) 285-1397
LICENSING EVALUATOR SIGNATURE:	DATE: 03/29/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/29/2021

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

LIC9099 (FAS) - (06/04)

Page: 1 of 2

Control Number 22-AS-20200218160802

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: REGENCY, THE	FACILITY NUMBER: 306005350
	VISIT DATE: 03/29/2021

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

facility and 10 medication aides hired at the facility. Interviews with staff revealed that on a given shift there could be anywhere from 5-12 staff on the floor to assist facility residents. Based on the information obtain there is not enough evidence to reflect there is not enough staff to meet residents needs.

Based on the information gathered during the investigation, interviews and review of all documents obtained, the Department is unable to ascertain if the allegation occurred as reported. Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove or refute the alleged violation occurred; therefore, this allegation is deemed Unsubstantiated.

An exit interview was conducted with Administrator via tele-visit a copy of the report was sent via email and an electronic email read receipt confirms receiving of the report. Administrator agrees to review, agrees to send the signed report via email.

SUPERVISOR'S NAME: Marina Stanic	TELEPHONE: (714) 703-2851
LICENSING EVALUATOR NAME: Ruth Martinez	TELEPHONE: (657) 285-1397
LICENSING EVALUATOR SIGNATURE:	DATE: 03/29/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/29/2021

LIC9099 (FAS) - (06/04)

Page: 2 of 2