565850112-7-21-2023-29-AS-DPEA-D2WVEY-20240229152304

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 565850112
Report Date: 07/21/2023
Date Signed: 07/21/2023 04:01:37 PM

Substantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
07/14/2023 and conducted by Evaluator Zabel Chochian

COMPLAINT CONTROL NUMBER: 29-AS-20230714174612

FACILITY NAME:	REGENCY PALMS OXNARD		FACILITY NUMBER:	565850112
ADMINISTRATOR:	KENNETH MAHLER		FACILITY TYPE:	740
ADDRESS:	1020 BISMARK LANE		TELEPHONE:	(805) 247-0227
CITY:	OXNARD	STATE: CA	ZIP CODE:	93033
CAPACITY:	127	CENSUS: 63	DATE:	07/21/2023
		UNANNOUNCED	TIME BEGAN:	10:15 AM
MET WITH:	Meshyll Filipinas		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

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Resident's apartment is a safety hazard

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Zabel Chochian conducted a complaint visit to investigate above allegations. Upon arrival LPA was informed that Executive Director is off today. At approximately 10:20am, LPA met with Wellness Director Meshyll Filipinas and reason for the visit was explained. A copy of the staff and resident roster was requested.

At approximate 10:45am LPA toured the facility with Ms. Filipinas. At 11:04am, Resident #1's (R1) room was toured and observed with multiple boxes of things all around; clutter of misalainious items all over the floor. There is no clear path to ambulate in this room which is a safety hazard. R1's bathroom is also cluttered with items all around with no clear path to ambulate. There was no clear path to go inside R1's room or bathroom. Based on the observation of R1's room during todays visit allegation "Resident's apartment is a safety hazard" is substantiated.
The following deficiency was cited (See LIC 9099-D) from the California Code of Regulations, Title 22 and/or California Health and Safety Code. Exit interview held. Copy of report and appeal rights provided.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Desaree Perera	TELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Zabel Chochian	TELEPHONE: (818) 419-5440
LICENSING EVALUATOR SIGNATURE:	DATE: 07/21/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2023

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 29-AS-20230714174612

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: REGENCY PALMS OXNARD	FACILITY NUMBER: 565850112
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 07/21/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 07/26/2023 Section Cited CCR 87303(a)	1 2 3 4 5 6 7	Maintenance and Operation: (a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors.This requirement is not met as evidenced by:	1 2 3 4 5 6 7	Wellness Director and Executive Direct informed LPA that they communicated with R1 and agreed to organize and clean room to ensure it is clean, safe and sanitary at all times. Submit photos of room and written self certification letter on how they will ensure compliance with section cited in the future.
	8 9 10 11 12 13 14	Based on today's observation of R1's room, the licensee did not comply with the section cited above as R1's room was observed to be cluttered with very limited to no path to ambulate. This poses a potential safety risk to resident in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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: Desaree Perera	TELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Zabel Chochian	TELEPHONE: (818) 419-5440
LICENSING EVALUATOR SIGNATURE:	DATE: 07/21/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2023

LIC9099 (FAS) - (06/04)

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