306005350-7-26-2022-22-AS-AORZ-CJRV5V-20220930160831

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306005350
Report Date: 07/26/2022
Date Signed: 07/26/2022 01:47:22 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
12/08/2020 and conducted by Evaluator Ruth Martinez

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20201208145317

FACILITY NAME:	REGENCY, THE		FACILITY NUMBER:	306005350
ADMINISTRATOR:	JUSTINE ORTIZ		FACILITY TYPE:	740
ADDRESS:	24441 CALLE SONORA		TELEPHONE:	(949) 830-8057
CITY:	LAGUNA WOODS	STATE: CA	ZIP CODE:	92637
CAPACITY:	220	CENSUS: 124	DATE:	07/26/2022
		UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Jennifer Turgeon		TIME COMPLETED:	02:00 PM

ALLEGATION(S):

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-Residents subjected to medical testing without proper consent

-Residents required to pay for unnecessary medical testing

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Ruth Martinez visited the facility to deliver findings for the investigation into the above identified complaint allegations. LPA arrive at facility was greeted by receptionist and granted entry. LPA spoke with Jennifer Turgeon, Administrator and explained the purpose of the visit.

Findings are based upon this investigation which include pertinent records review.
It is alleged that facility residents are subjected to medical testing without proper consent and residents required to pay for unnecessary medical testing. Records review revealed that R1 signed an informed consent for COVID-19 test screening. Consent form indicates the following: COVID-19 testing is available through nasal swabs to determine if you have a COVID-19 infection. Senior Resource Group, LLC together with any affiliated entities associated with the community in which you reside (collectively, "SRG") are offering the nasal swab

Continued on LIC9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Sheila Santos	TELEPHONE: (714) 334-2062
LICENSING EVALUATOR NAME: Ruth Martinez	TELEPHONE: (657) 285-1397
LICENSING EVALUATOR SIGNATURE:	DATE: 07/26/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/26/2022

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-20201208145317

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: 07/26/2022

NARRATIVE

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testing to residents who wish to have such testing performed. The nasal swab test takes approximately 10 seconds to collect. You may experience some discomfort during the collection process. Once the sample is taken, it is put into a sterile container and sent for processing. A PCR analysis will be performed to determine whether you have a COVID-19 infection. Results will typically be available within 72-hours. Cost & Insurance Coverage Residents' Medicare or Medicare Advantage plan will fully cover the costs associated with the testing. Residents will have $0 out of pocket costs associated with the testing. Any follow-up care indicated by the testing will be at resident's expense subject to any applicable health insurance. Testing Consent I have read the above information about COVID-19 and have had a chance to ask questions. I understand the risks and benefits of this swab testing. I further understand that I am consenting to have my test results delivered to SRG who will inform me of the results. If I am informed of a positive result for COVID-19, I understand that I will be expected to contact my physician immediately. If I test negative for COVID-19, I understand that I was not likely infected at the time my specimen was collected. However, I understand that a negative test result does not rule out that I may get sick later or that the test could have produced a false negative, and I will continue taking all needed precautions to minimize my risk of exposure. I further understand that SRG will make the test results available to me and my physician. Furthermore, test result order profile indicates the following: 2019-nCoV Test result Disclaimer: This test, a RT-PCR nucleic acid assay, was developed at Magnolia Diagnostics following CDC instructions and therefore has FDA's Emergency Use Authorization (EUA). This test is intended for the presumptive qualitative detection of nucleic acid from the 2019-nCoV in upper and lower respiratory specimens (such as nasopharyngeal, anterior nares swabs or oropharyngeal swabs, sputum, lower respiratory tract aspirates, bronchoalveolar lavage, and nasopharyngeal wash/aspirate or nasalaspirate) collected from Individuals who meet CDC criteria for 2019-nCoV testing. Test performed indicates it was only for detection of COVID-19 virus.

Based on the information mentioned above, 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, these allegations are deemed Unsubstantiated.

An exit interview was conducted with Administrator and a copy of this LIC9099 report was left at facility.

SUPERVISOR'S NAME: Sheila Santos	TELEPHONE: (714) 334-2062
LICENSING EVALUATOR NAME: Ruth Martinez	TELEPHONE: (657) 285-1397
LICENSING EVALUATOR SIGNATURE:	DATE: 07/26/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/26/2022

LIC9099 (FAS) - (06/04)

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