347005940-6-11-2021-27-AS-SRIN-C4H3AN-20210630180502

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 347005940
Report Date: 06/11/2021
Date Signed: 06/11/2021 05:24:46 PM

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
11/16/2020 and conducted by Evaluator Christina Valerio

COMPLAINT CONTROL NUMBER: 27-AS-20201116162628

FACILITY NAME:	REGENCY PLACE		FACILITY NUMBER:	347005940
ADMINISTRATOR:	HARUMI HURRIANKO		FACILITY TYPE:	740
ADDRESS:	8190 ARROYO VISTA DR		TELEPHONE:	(916) 681-7800
CITY:	SACRAMENTO	STATE: CA	ZIP CODE:	95823
CAPACITY:	55	CENSUS: 76	DATE:	06/11/2021
		UNANNOUNCED	TIME BEGAN:	10:45 AM
MET WITH:	Administrator Harumi Harrianko and Business Office Manager Elizabeth Cruz		TIME COMPLETED:	11:25 AM

ALLEGATION(S):

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Personal Rights
Facility Understaffs

INVESTIGATION FINDINGS:

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On 06/11/21 at 10:45 AM, Licensing Program Analyst (LPA) Christina Valerio arrived at the facility unannounced to deliver investigation complaint findings. LPA Valerio was met at the door by Administrator Harumi Harrianko and Business Office Manager Elizabeth Cruz. LPA Valerio introduced herself and discussed the purpose of the visit. Prior to entering the facility, LPA Valerio was screened for COVID-19 symptoms and temperatures were taken.

The investigation was conducted by LPA Suong Teh and LPA Christina Valerio and consisted of interviews with Facility Staff (Administrator, S1-S3), interviews with residents (R1-R5), and a review of facility records.

LPA has determined the following as it relates to the above complaint allegations.

Continued LIC 9099 - C...

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Stephen Richardson	TELEPHONE: (916) 263-4746
LICENSING EVALUATOR NAME: Christina Valerio	TELEPHONE: 916-823-6323
LICENSING EVALUATOR SIGNATURE:	DATE: 06/11/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/11/2021

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 27-AS-20201116162628

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: 347005940
	VISIT DATE: 06/11/2021

NARRATIVE

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Continued from LIC 9099...

On 11/17/21 at 12:36PM, LPA Teh interviewed Administrator Harumi, Administrator confirmed that on 10/20/2020 in the memory care unit, Resident 1 (R1) reported to her that Resident 2 (R2) tried to take her walker away and when R1 tried to grab her walker back R2 made contact with R1's shoulder. Harumi stated that staff checked on R1's shoulder and did not find any bruises.

On 06/07/21 at 4:30 PM, LPA Valerio reviewed resident records. LPA observed 2 incident reports dated 07/15/2020 and 10/20/2020 sent by Administrator Harumi reporting incidents between R1 and R2. Both incident reports indicated that R2 had made physical contact with R1. No injuries were noted, responsible parties were notified, and R1 and R2 were observed for 48 hours.

On 06/07/21 at 5:15PM, LPA Valerio interviewed Staff 1 (S1). S1 reported that she does not recall any personal rights being violated. that she could not remember the specific incident between R1 and R2. S1 reported that R2 does not know what she is doing. R2 talks to the other residents and will get mad because the residents are doing their own thing. R2 will shove them or do something physical.

On 06/11/21 at 9:00 AM, LPA Valerio interviewed Staff 2 (S2), S2 stated that no personal rights on the memory care side have been violated and she cannot speak to assisted living. S2 stated that there is a resident (R6) who takes other residents food or tries to hit residents when R6 gets mad. S2 stated that when an incident like that happens, the staff pulls R6 away.

On 06/11/21 at 8:43 AM, LPA Valerio interviewed Staff 3 (S3), S3 stated that she does not recall any incidents right now. S3 stated "maybe before, but I am not sure. We are good, nothing bad happen."

On 06/07/21 at 5:03 PM, LPA Valerio and LPM Richardson attempted to interview R1, R2, R3, R5. Interviews with R1, R2, R3, R5 were deemed unsuccessful. R4 was unable to be interviewed due to no longer being at the facility.

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SUPERVISOR'S NAME: Stephen Richardson	TELEPHONE: (916) 263-4746
LICENSING EVALUATOR NAME: Christina Valerio	TELEPHONE: 916-823-6323
LICENSING EVALUATOR SIGNATURE:	DATE: 06/11/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/11/2021

LIC9099 (FAS) - (06/04)

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Control Number 27-AS-20201116162628

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: 347005940
	VISIT DATE: 06/11/2021

NARRATIVE

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On 06/07/21 at 4:28 PM, LPA Valerio reviewed the staff schedule for the Assisted Living and Memory Care sides for October 2020, November 2020, and December 2020. Staff schedules show that there is at least two staff members present for AM shift, PM shift, and NOC shift. On 11/17/20 at 12:36PM, LPA Teh interviewed Administrator Harumi, Administrator stated and confirmed that the facility currently is not understaffed in the Assisted Living side and the Memory Care side.

On 06/07/21 at 3:36 PM, LPA Valerio and LPM Richardson reviewed staff scheduled. LPA Valerio observed 2 staff on shift for AM shift, PM shift, and NOC shift for October 2020 and November 2020. During the interview with Administrator Harumi on 06/07/21, Harumi stated to LPA Valerio and LPM Richardson the organization policy is to have 2 caregiver staff for the Assisted Living (AL) side, 2 caregiver staff for the Memory Care (MC) side, and 1 medication technician for both the AL and MC side.

On 06/07/21 at 5:15PM, LPA Valerio interviewed Staff 1 (S1). S1 reported that the facility is always understaffed. When people call out, staff have to stay over until coverage is found. When one caregiver goes on a lunch break, there is only one caregiver staff by themselves to care for the residents. The medication technician is the backup but cannot be stay for long due to covering both AL and MC sides of the facility.

On 06/11/21 at 9:00 AM, LPA Valerio interviewed Staff 2 (S2), S2 stated that the facility might have been understaffed before she was hired in January 2020. While S2 was employed January - July 2020, they were not understaffed. At times, there would be 4 staff on shift.

On 06/11/21 at 8:43 AM, LPA Valerio interviewed Staff 3 (S3), S3 stated staffing is good and she has never felt that it was under staffed. There are 3 people (2 caregivers and 1 medication technician) at all times on each side.

Based on all the information collected by the Department there is not a preponderance of evidence to prove the allegation occurred, therefore this allegation is UNSUBSTANTIATED. Due to the above noted information, although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, and therefore the allegations are unsubstantiated.

Per California Code of Regulations (CCRs) - Title 22, Division 6, Chapter 8, no deficiencies cited. Exit interview was held and a copy of report was given to Administrator Harumi Harrianko

SUPERVISOR'S NAME: Stephen Richardson	TELEPHONE: (916) 263-4746
LICENSING EVALUATOR NAME: Christina Valerio	TELEPHONE: 916-823-6323
LICENSING EVALUATOR SIGNATURE:	DATE: 06/11/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/11/2021

LIC9099 (FAS) - (06/04)

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