342701107-2-22-2023-27-AS-SRIN-CPW3KJ-20230313181913

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 342701107
Report Date: 02/22/2023
Date Signed: 02/22/2023 11:04:57 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833

This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/14/2022 and conducted by Evaluator Jamie Ivey-Canady

COMPLAINT CONTROL NUMBER: 27-AS-20221014152649

FACILITY NAME:	REGENCY PLACE		FACILITY NUMBER:	342701107
ADMINISTRATOR:	CRUZ, ELIZABETH		FACILITY TYPE:	740
ADDRESS:	8190 ARROYO VISTA DRIVE		TELEPHONE:	(916) 681-7800
CITY:	SACRAMENTO	STATE: CA	ZIP CODE:	95823
CAPACITY:	61	CENSUS: 45	DATE:	02/22/2023
		UNANNOUNCED	TIME BEGAN:	10:35 AM
MET WITH:	Elizabeth Cruz		TIME COMPLETED:	11:00 AM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Facility did not seek medical attention in a timely manner.

INVESTIGATION FINDINGS:

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

Licensing Program Analyst (LPA)s Jamie Ivey Canady arrived at the facility unannounced to deliver complaint investigation findings. LPA Ivey Canady explained the purpose of the visit and was met by Elizabeth Cruz.

The investigation was conducted by the Department. The investigation consisted of interviews with staff, review of resident medical reports, facility chart notes and facility resident files.

The Department has determined the following as it relates to the allegations: Facility did not seek medical attention in a timely manner. This allegation was originally substantiated on 1/23/2023 and due to Department audit has been amended to remove the finding of substantiated and replace with unsubstantiated.

Continued on LIC 9099 - C...
Page 1 of 2

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Stephen Richardson	TELEPHONE: (916) 263-4746
LICENSING EVALUATOR NAME: Jamie Ivey-Canady	TELEPHONE: 916-263-4700
LICENSING EVALUATOR SIGNATURE:	DATE: 02/22/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/22/2023

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 27-AS-20221014152649

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833

FACILITY NAME: REGENCY PLACE	FACILITY NUMBER: 342701107
	VISIT DATE: 02/22/2023

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

According to incident reports received from the facility and medical document review, in the early hours of 2 am on 9/17/2022 R1 had an unwitnessed fall. R1 was discovered at 2 am on 9/17/2022 by S2 and assisted back to bed. According to interview with S2, S2 performed a wellness check of R1 at approximately 2 pm later that same day and stated R1 was doing well. S2 stated the wellness check was an assessment due to the unwitnessed fall. Because the facility did respond once the notification was received from R1 there was pain, by contacting the doctor’s office, the allegation Facility did not seek medical attention in a timely manner is UNSUBSTANTIATED. An unsubstantiated finding means although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

SUPERVISOR'S NAME: Stephen Richardson	TELEPHONE: (916) 263-4746
LICENSING EVALUATOR NAME: Jamie Ivey-Canady	TELEPHONE: 916-263-4700
LICENSING EVALUATOR SIGNATURE:	DATE: 02/22/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/22/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 2