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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 342701107
Report Date: 06/30/2026
Date Signed: 06/30/2026 02:27:17 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/27/2026 and conducted by Evaluator Shakaricka Hughes
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20260427095649
FACILITY NAME:REGENCY PLACEFACILITY NUMBER:
342701107
ADMINISTRATOR:HEIDI CHARETTEFACILITY TYPE:
740
ADDRESS:8190 ARROYO VISTA DRIVETELEPHONE:
(916) 681-7800
CITY:SACRAMENTOSTATE: CAZIP CODE:
95823
CAPACITY:61CENSUS: 78DATE:
06/30/2026
UNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Administrator: Martin NicholsTIME COMPLETED:
02:30 PM
ALLEGATION(S):
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Facility allows untrained staff to dispense medications to residents.
INVESTIGATION FINDINGS:
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On 06/30/2026, Licensing Program Analyst (LPA) Shakaricka Hughes arrived unannounced to this facility to conduct a complaint visit. LPA met with the facility administrator Martin and explained the purpose of the visit. The purpose of this visit is to deliver complaint findings for the allegation above. The current census is 78.

Allegation: Facility allows untrained staff to dispense medications to residents
It was alleged that the facility allows untrained staff to dispense medications to residents. This investigation consisted of interviews with facility staff, and records review. On 04/27/2026 LPA Hughes conducted a visit to the facility and spoke with two (2) facility staff who stated that they have received a combination of hands-on and online training medication administration training. LPA reviewed on-going facility training records for five (5) medication technicians and did not identify any discrepancies in the required medication administration training. LPA also reviewed training records for (S3) and verified that (S3) had completed medication administration training.

Continuation 9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Czarrina A Camilon-Lee
LICENSING EVALUATOR NAME: Shakaricka Hughes
LICENSING EVALUATOR SIGNATURE:

DATE: 06/30/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/30/2026
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 5
Control Number 27-AS-20260427095649
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: REGENCY PLACE
FACILITY NUMBER: 342701107
VISIT DATE: 06/30/2026
NARRATIVE
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On 06/30/2026, LPA Hughes conducted a follow-up visit to the facility and interviewed two (2) caregivers who stated they do not administer medication to residents in care and only medication technicians are responsible for medication administration within the facility. Based on the information obtained during the investigation, there was insufficient evidence to corroborate this allegation. Therefore, the allegation is unsubstantiated.

The investigation revealed the preponderance of evidence standards have not been met; therefore, the above allegations are found to be UNSUBSTANTIATED. A finding that the complaint allegations are UNSUBSTANTIATED means that although the allegations may have happened or are valid, there is not a preponderance of the evidence to prove that the alleged violation occurred.
SUPERVISORS NAME: Czarrina A Camilon-Lee
LICENSING EVALUATOR NAME: Shakaricka Hughes
LICENSING EVALUATOR SIGNATURE:

DATE: 06/30/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/30/2026
LIC9099 (FAS) - (06/04)
Page: 5 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/27/2026 and conducted by Evaluator Shakaricka Hughes
PUBLIC
COMPLAINT CONTROL NUMBER: 27-AS-20260427095649

FACILITY NAME:REGENCY PLACEFACILITY NUMBER:
342701107
ADMINISTRATOR:HEIDI CHARETTEFACILITY TYPE:
740
ADDRESS:8190 ARROYO VISTA DRIVETELEPHONE:
(916) 681-7800
CITY:SACRAMENTOSTATE: CAZIP CODE:
95823
CAPACITY:61CENSUS: 78DATE:
06/30/2026
UNANNOUNCEDTIME BEGAN:
01:30 PM
MET WITH:Administrator: Martin NicholsTIME COMPLETED:
02:30 PM
ALLEGATION(S):
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Staff did not ensure reporting requirements were followed,
INVESTIGATION FINDINGS:
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On 06/30/2026, Licensing Program Analyst (LPA) Shakaricka Hughes arrived unannounced to this facility to conduct a complaint visit. LPA met with the facility administrator Martin and explained the purpose of the visit. The purpose of this visit is to deliver complaint findings for the allegation above. The current census is 78.

Allegation: Staff did not ensure reporting requirements were followed
It was alleged that staff did not ensure reporting requirements were followed. This investigation consisted of interviews with facility staff, and records review. On 04/27/2026, LPA Hughes conducted a visit to the facility and interviewed (2) facility staff regarding an incident that occurred on 04/18/2026. Interview with facility staff (S1) revealed that following the incident, staff on duty did not report the incident to Community Care Licensing Division (CCLD) or facility management and instead continued their normal duties. Additionally, the facility coordinator stated that they did not become aware of the incident until 04/20/2026, when they received a text message from facility staff (S2) describing the incident that occurred.

Continuation 9099-C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Czarrina A Camilon-Lee
LICENSING EVALUATOR NAME: Shakaricka Hughes
LICENSING EVALUATOR SIGNATURE:

DATE: 06/30/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/30/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 27-AS-20260427095649
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME: REGENCY PLACE
FACILITY NUMBER: 342701107
VISIT DATE: 06/30/2026
NARRATIVE
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LPA reviewed a LIC 624 Unusual Incident/Injury Report submitted by the facility on 04/22/2026 which contained incomplete and inaccurate information regarding the incident. This was observed not in compliance with Title 22 regulation 87211(c), as the facility did not ensure that reporting requirements were followed by timely reporting suspected physical abuse to the appropriate agencies within the required time frame.

As a result, this allegation is SUBSTANTIATED. A finding that the complaint is substantiated means that the allegations are valid because the preponderance of the evidence standard has been met. Deficiencies cited on the LIC 9099-D, per Title 22 Regulations. An exit interview was conducted with Martin and a copy of the LIC 9099, LIC 9099-D pages and appeal rights were provided to facility.
SUPERVISORS NAME: Czarrina A Camilon-Lee
LICENSING EVALUATOR NAME: Shakaricka Hughes
LICENSING EVALUATOR SIGNATURE:

DATE: 06/30/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/30/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 27-AS-20260427095649
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827

FACILITY NAME: REGENCY PLACE
FACILITY NUMBER: 342701107
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/30/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/03/2026
Section Cited
CCR
87211(c)
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87211 Reporting Requirements (c) Any suspected physical abuse that does not result in serious bodily injury of an elder or dependent adult shall be reported to the local ombudsman, the corresponding licensing agency, and the local law enforcement agency within twenty-four (24) hours as required....
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The facility agrees to remain in compliance with Title 22 regulation 87211(c) at all times. The facility has conducted mandated reporter training for facility staff. The facility agrees to review the regulation cited and write a statement of acknowledgment of the regulation and send to LPA Hughes by 07/03/2026.
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This requirement was not met as evidenced by:
The facility did not ensure that reporting requirements were followed by timely reporting an incident of physical abuse of a resident (R1) to the appropriate agencies within the required timeframe of 24 hrs.

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The facility agrees to review the regulation cited and write a statement of acknowledgment of the regulation and send to LPA Hughes by 07/03/2026.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Czarrina A Camilon-Lee
LICENSING EVALUATOR NAME: Shakaricka Hughes
LICENSING EVALUATOR SIGNATURE:

DATE: 06/30/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/30/2026
LIC9099 (FAS) - (06/04)
Page: 4 of 5