306005350-5-16-2023-22-AS-AORZ-CS5LYN-20230524091033

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306005350
Report Date: 05/16/2023
Date Signed: 05/16/2023 02:50:06 PM

Substantiated

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
05/08/2023 and conducted by Evaluator Andrea Mendivil

COMPLAINT CONTROL NUMBER: 22-AS-20230508160159

FACILITY NAME:	REGENCY, THE		FACILITY NUMBER:	306005350
ADMINISTRATOR:	JENNIFER TURGEON		FACILITY TYPE:	740
ADDRESS:	24441 CALLE SONORA		TELEPHONE:	(949) 830-8057
CITY:	LAGUNA WOODS	STATE: CA	ZIP CODE:	92637
CAPACITY:	220	CENSUS: 106	DATE:	05/16/2023
		UNANNOUNCED	TIME BEGAN:	01:30 PM
MET WITH:	Elena Madsen- Executive Director		TIME COMPLETED:	03:15 PM

ALLEGATION(S):

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Facility is misrepresenting itself

INVESTIGATION FINDINGS:

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On this day Licensing Program Analyst (LPA) Andrea Mendivil made an unannounced visit to conduct a complaint investigation. LPA was greeted and granted entry into the facility by Elena Madsen and explained the reason for the visit.

The department received a complaint on 05/09/2023 and the initial 10 day visit was conducted on 05/16/2023. During the visit the department reviewed the facility website and advertisements. In regard to the allegation facility is misrepresenting itself, the investigation revealed the following:

It was reported by a witness that the facility is operating under the name Ivy Park at Laguna Woods. Based on interviews with staff the facility has used the name Ivy Park at Laguna Woods since around 07/01/2022. Executive Director Elena Madsen reported that the facility Ivy Park at Laguna Woods license is currently pending and they are operating under The Regency license.

Substantiated

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: 05/16/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2023

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-20230508160159

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
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 05/16/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Deficiency Dismissed Type B 05/22/2023 Section Cited CCR 87207	1 2 3 4 5 6 7	No licensee, officer or employee of a licensee shall make or disseminate any false or misleading statement regarding the facility or any of the services provided by the facility. This requirement was not met as evidence by the facility is advertising under a different name that is not currently licensed.	1 2 3 4 5 6 7	Executive DIrector to update website to reflect that they are using the license of the Regency and forward proof to LPA by POC due date
	8 9 10 11 12 13 14	This poses a potential risk to persons in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Alisa Ortiz	TELEPHONE: (714) 703-4084
LICENSING EVALUATOR NAME: Andrea Mendivil	TELEPHONE: 714-703-2738
LICENSING EVALUATOR SIGNATURE:	DATE: 05/16/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2023

LIC9099 (FAS) - (06/04)

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Control Number 22-AS-20230508160159

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: 05/16/2023

NARRATIVE

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Therefore based on the preponderance of evidence through observation and interviews the allegation that the facility is misrepresenting itself is determined to be SUBSTANTIATED, meaning a violation has occurred.

The following is being cited per California Code of Regulations Title 22 Division 6 Chapter 8.
An exit interview was conducted with Executive Director and a copy of this report, LIC9099-D, and appeal rights was provided at the time of exit.

SUPERVISOR'S NAME: Alisa Ortiz	TELEPHONE: (714) 703-4084
LICENSING EVALUATOR NAME: Andrea Mendivil	TELEPHONE: 714-703-2738
LICENSING EVALUATOR SIGNATURE:	DATE: 05/16/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/16/2023

LIC9099 (FAS) - (06/04)

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