306005350-3-29-2021-22-AS-AORZ-C2JN4Y-20210429100841

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306005350
Report Date: 03/29/2021
Date Signed: 03/29/2021 12:57:06 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-20200218141327

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):

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-Facility is not safeguarding resident's valuables
-Staff caused injury to resident during shower
-Resident's sustained multiple falls while in care
-Staff do not respond timely to resident's alert calls
-Facility does not have auditory alert device to monitor exits for dementia residents
-Facility is not following physician's order for administering medication
-Residents have narcotics stolen from their room
-Residents are served food that is not conducive to their faith or diet

INVESTIGATION FINDINGS:

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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 allegations. 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 is not safeguarding resident’s valuables, staff caused injury to resident during shower, resident sustained multiple falls while in care, staff do not respond timely to resident’s alert calls, facility does not have auditory alert devices to monitor exits for dementia residents, facility is not following physician’s order
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)

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Control Number 22-AS-20200218141327

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

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for administering medication, residents have narcotics stolen from their room, and residents are served food that is not conductive to their faith and diet.

The investigation revealed the following: LIC9060 resident theft and loss records, LIC624 facility incident report, interviews and investigation conducted by facility indicate that resident trust facility staff and feels like item was lost or misplaced. As a result, R2 did not feel the need to call PD to report incident. Facility conducted an in-house training to all staff in December of 2019 and conducted a re in-service in February 2020 after incident. Based on the information reviewed there is not enough evidence to indicate that facility is not safeguarding residents’ belongings. In review of resident records and LIC624 incident reports submitted to Department there is no record or indication that R3 had a fall or injury while in the shower. Resident resided at facility from 05/17/2017 to 06/23/2020. Records indicated that resident has had three fall incidents throughout stay at facility with minor skin tears, all falls reported, and resident sent out to hospital for evaluation to insure resident’s wellbeing. Progress notes for December 23, 2019 indicates that R3 had a visit to physical therapy which opened up a skin tear from a previous fall. Records review does not reflect an incident to R3 while in the shower. Furthermore, records indicate R3 has had multiple falls during the course of R3's stay at facility however facility has taken all measures to make sure R3 was evaluated and taken care of. Progress report also reflects when pendant isn’t cleared right away front desk staff will check in on residents. WanderGuard activity reports reflects all pendant activated calls reset due to staff assisting R3. Report activity reflects in one given month 66 times pendant was activated and 66 times pendant was reset with a response time of 8 seconds to a 40 minute time span. Device activity report for multiple residents indicate pendant activation calls have been responded with same amount of time. Health and service evaluation report indicate R1 had escorting level of assistance with one person assisting with wheelchair. R4’s health and service evaluation report indicate safety checks-wanderguard 4x per shift. Furthermore, has escorting level of assistance with one person assist to meals, activities, etc. Wanderguard blue controllers for doors reflect facility has a weekly maintenance check on all common doors in facility. Facility auditory alert devices for door monitoring reflect common doors have and alert and has no sufficient evidence to indicate residents can wander out of facility without an alert. LPA reviewed 10% of resident census centrally stored medication logs which would indicate resident’s medication is in custody of the facility and is logged upon distribution of medication to residents. All logs reviewed reflect staff initials for medication given as indicated in physician’s order instructions. Upon review of logs medication has been given as indicated on prescription and indicated in the notes section when resident refuses medication. Information provided to indicate that residents have ability to request for PRN
CONTINUED ON LIC9099-C

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)

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Control Number 22-AS-20200218141327

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

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medication as needed. Medication is under the control of the facility and distributed by a medication aid as needed. Based on the information obtained medication is under the control of the facility and is properly logged when medication is distributed to residents. LPA obtained a copy of the facility weekly menu for review and observed the food service to be well balanced with a variety of choices. Interviews indicated that generally, residents have no complaints about the quality but have different preferences of food served in which the facility accommodate to request as best as possible. Based on the information reviews there isn’t enough evidence to prove that food service is not of quality to meet the 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 allegations 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 violations occurred; therefore, this allegations 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)

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