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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 565850112
Report Date: 12/06/2023
Date Signed: 12/06/2023 02:17:56 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/27/2023 and conducted by Evaluator Esther Cortez
COMPLAINT CONTROL NUMBER: 29-AS-20231127163113
FACILITY NAME:REGENCY PALMS OXNARDFACILITY NUMBER:
565850112
ADMINISTRATOR:KENNETH MAHLERFACILITY TYPE:
740
ADDRESS:1020 BISMARK WAYTELEPHONE:
(805) 247-0227
CITY:OXNARDSTATE: CAZIP CODE:
93033
CAPACITY:127CENSUS: 72DATE:
12/06/2023
UNANNOUNCEDTIME BEGAN:
09:20 AM
MET WITH:Kenneth MahlerTIME COMPLETED:
02:20 PM
ALLEGATION(S):
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Staff did not ensure that a facility door was locked, resulting in resident leaving the facility unsupervised.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Esther Cortez arrived announced to conduct a 10-day Complaint visit to the facility above. The LPA met with Administrator Kenneth Mahler and explained the purpose of the visit.

The LPA requested Resident 1 (R1's) preplacement Appraisal, LIC.602A Physicians report, Appraisal Needs and Services Plan, staff roster, residents’ roster, and incident report. The LPA conducted interviews with the Administrator, two (2) Staff and R1, and toured the memory care unit with staff between 9:30 a.m. – 11:30 a.m.

On the allegation Staff did not ensure that a facility door was locked, resulting in resident leaving the facility unsupervised, it is the reporting party’s concern that a resident with dementia had run away from the facility and did not want to return. To investigate the allegation, the LPA conducted interviews, and a file review. File review revealed that R1 has a diagnosis of Dementia and cannot leave the facility unassisted. Report will continue on LIC9099-C.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Kasandra LopezTELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Esther CortezTELEPHONE: (747) 230-2225
LICENSING EVALUATOR SIGNATURE:

DATE: 12/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/06/2023
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 5
Control Number 29-AS-20231127163113
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: REGENCY PALMS OXNARD
FACILITY NUMBER: 565850112
VISIT DATE: 12/06/2023
NARRATIVE
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 All staff interviews revealed that on 11/26/2023 the facility experienced an unexpected power outage that triggered all of the exit doors. Staff immediately went to check the exit doors, conducted a headcount, and realized R1 was missing, and began to look for them. R1’s interview revealed that R1’s bedroom is near an exit door at the end of the hallway, they noticed the lights blinking and went out the exit door as they were trying to go to the bank and their house. Neighbors noticed R1 and called the police and R1 was taken to the hospital as they did not want to return to the facility. The facility failed to submit an unusual incident report (LIC624) to CCL and provided a copy of the incident report to the LPA during today’s visit. LIC 624 confirmed that R1 had walked out of the building and taken to the hospital for testing/evaluation after 911 was called by a neighbor. Based on the evidence this allegation is Substantiated at this time.

Exit interview conducted, deficiency cited, copy of report and appeal rights printed for Administrator Ken.
SUPERVISOR'S NAME: Kasandra LopezTELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Esther CortezTELEPHONE: (747) 230-2225
LICENSING EVALUATOR SIGNATURE:

DATE: 12/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/06/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 5
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/27/2023 and conducted by Evaluator Esther Cortez
COMPLAINT CONTROL NUMBER: 29-AS-20231127163113

FACILITY NAME:REGENCY PALMS OXNARDFACILITY NUMBER:
565850112
ADMINISTRATOR:KENNETH MAHLERFACILITY TYPE:
740
ADDRESS:1020 BISMARK WAYTELEPHONE:
(805) 247-0227
CITY:OXNARDSTATE: CAZIP CODE:
93033
CAPACITY:127CENSUS: 72DATE:
12/06/2023
UNANNOUNCEDTIME BEGAN:
09:20 AM
MET WITH:Kenneth MahlerTIME COMPLETED:
02:20 PM
ALLEGATION(S):
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Staff locks resident in their room.
Staff does not ensure that resident is adequately fed.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Esther Cortez arrived announced to conduct a 10-day Complaint visit to the facility above. The LPA met with Administrator Kenneth Mahler and explained the purpose of the visit.

The LPA requested Resident 1 (R1's) preplacement Appraisal, LIC.602A Physicians report, Appraisal Needs and Services Plan, staff roster, residents’ roster, and incident report. The LPA conducted interviews with the Administrator, two (2) Staff and R1, and toured the memory care unit with staff between 9:30 a.m. – 11:30 a.m.

Report will continue on LIC9099-C.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Kasandra LopezTELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Esther CortezTELEPHONE: (747) 230-2225
LICENSING EVALUATOR SIGNATURE:

DATE: 12/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/06/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 29-AS-20231127163113
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: REGENCY PALMS OXNARD
FACILITY NUMBER: 565850112
VISIT DATE: 12/06/2023
NARRATIVE
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On the allegation Staff locks resident in their room, it is the reporting party’s concern that the facility mistreats R1 and locks them in their room. To investigate the allegation, the LPA conducted interviews and toured the memory care unit. R1’s interview revealed that even though they would rather be somewhere else with their family, staff treats them “pretty darn good,” and they would select the facility to be in if it was necessary. At 11:26 a.m. the LPA observed R1’s bedroom to only have a lock from the inside of the bedroom. Staff interviews revealed that all bedrooms in memory care have keylocks and bedrooms generally stay unlocked unless requested to be locked by family members. If the doors are to remain locked, the resident must be able to walk and be able to unlock the door and a note on the door would be placed. Bedrooms are to be locked from the outside to prevent people from coming in. The LPA did not observe a note on R1’s door with the indication the door to be locked. Based on the information gathered on the above allegation, although the allegation may have happened or is valid, there was insufficient evidence to confirm that “Staff locks resident in their room”. Therefore, the allegation is deemed UNSUBSTANTIATED at this time.

On the allegation Staff does not ensure that resident is adequately fed, it is the reporting party’s concern that the facility does not feed resident appropriately. To investigate the allegation, the LPA conducted interviews and toured the memory care unit. R1’s interview revealed that even though they do not like the food being served at the facility, they are provided three (3) meals a day and they are not left hungry. At 11:09 a.m. the LPA observed enchiladas, rice, vegetables, smashed potatoes, and a dessert being served for lunch to the residents in care in the memory care unit. At 11:25 a.m. the LPA observed R1 eating their lunch. Staff interview revealed that the facility provides breakfast at 8:00 a.m., lunch at 11:00 a.m., dinner at 4:00 p.m. and snacks in between. Based on the information gathered on the above allegation, although the allegation may have happened or is valid, there was insufficient evidence to confirm that “Staff does not ensure that resident is adequately fed”. Therefore, the allegation is deemed UNSUBSTANTIATED at this time.

Exit interview and report reviewed with Administrator Ken. A copy of the report and appeal rights were provided.

SUPERVISOR'S NAME: Kasandra LopezTELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Esther CortezTELEPHONE: (747) 230-2225
LICENSING EVALUATOR SIGNATURE:

DATE: 12/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/06/2023
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 29-AS-20231127163113
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: REGENCY PALMS OXNARD
FACILITY NUMBER: 565850112
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/06/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
12/13/2023
Section Cited
CCR
87464(f)(1)
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87464(f) Basic services shall at a minimum include:(1) Care and supervision as defined in Section 87101(c)(3) and Health and Safety Code section 1569.2(c). This requirement was not met as evidenced by:
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The administrator agreed to hold an all memory care staff training for supervision of residents, duties, responsibilities, elopement procedures, and on audible alarm sounds and responses. Provide proof of training with all staff signatures to CCL by 12/13/2023.
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Based on interviews the licensee did not comply with the regulation above, R1 who is diagnose with dementia was able to leave through the unlocked exit door and walk across the street off the property which poses an immediate health and safety risk to residents in care.
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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.
SUPERVISOR'S NAME: Kasandra LopezTELEPHONE: (818) 596-4343
LICENSING EVALUATOR NAME: Esther CortezTELEPHONE: (747) 230-2225
LICENSING EVALUATOR SIGNATURE:

DATE: 12/06/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/06/2023
LIC9099 (FAS) - (06/04)
Page: 5 of 5