<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 565850112
Report Date: 09/29/2022
Date Signed: 09/29/2022 05:49:49 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
09/21/2022 and conducted by Evaluator Kasandra Lopez
COMPLAINT CONTROL NUMBER: 29-AS-20220921104212
FACILITY NAME:REGENCY PALMS OXNARDFACILITY NUMBER:
565850112
ADMINISTRATOR:KENNETH MAHLERFACILITY TYPE:
740
ADDRESS:1020 BISMARK LANETELEPHONE:
(805) 247-0227
CITY:OXNARDSTATE: CAZIP CODE:
93033
CAPACITY:127CENSUS: 54DATE:
09/29/2022
UNANNOUNCEDTIME BEGAN:
10:58 AM
MET WITH:Kenneth MahlerTIME COMPLETED:
04:05 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Administrator is not providing a former resident prompt access to receive a copy of their facility records
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) KaSandra Lopez conducted an unannounced initial 10 day complaint inspection at the facility today regarding the above allegation. The LPA met with Administrator Ken Mahler and explained the reason for today's inspection.

The allegation of 'Administrator is not providing a former resident prompt access to receive a copy of their resident records' alleges that the Resident #1 (R1) has requested a copy of their medical records several times from the facility since they moved out in approximately February 2022 but they still have not received their records. On 09/09/2022, LPA Lopez was included on an email that was forwarded to the Administrator from R1 requesting a copy of their medical records be mailed to them with mailing address being provided.

Report continued on LIC 9099-C.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Desaree PereraTELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Kasandra LopezTELEPHONE: (818) 421-5183
LICENSING EVALUATOR SIGNATURE:

DATE: 09/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/29/2022
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 3
Control Number 29-AS-20220921104212
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
VISIT DATE: 09/29/2022
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
The email received by the Administrator on 09/09/2022 stated the following: "This is written request for my medical records for the time I was at the residence. It would include the medications given to me and who dispensed them to me. Also communications from any/all of the Doctors who I was a patient of at the same time. I have spoken to you about this in March and you assured me it would be taken care of.", with the mailing address provided for which the records were to be mailed to. The Administrator responded to the email on 09/09/2022 requesting an "Authorization for release of records" form be completed by R1 of which R1 requested this form be mailed to them.

During today's inspection, the LPA conducted an interview with the Administrator who stated they mailed the release form to R1 on 09/09/2022 so R1 could indicate which records they wanted and had not received the completed form back from the resident. The Administrator stated the Regional Nurse advised him of the licensee's policy of the authorization for release of records form needing to be completed. The Administrator stated the 09/09/2022 email was the first notification he received from R1 requesting a copy of their records. The LPA conducted a telephone interview with the Regional Nurse, Staff #1 (S1) at 2:39 PM. S1 stated for current residents they release records immediately on request but for former residents, family members, etc. it is a facility policy for the release form to be completed first. The LPA also reviewed R1's signed admission agreement and did not observe any written notification or advisory about this facility policy.

Today, the LPA also conducted a telephone interview with R1 who stated they received the release of records form and will be completing and returning it but stated they already informed the Administrator what records they wanted in writing in the email previously sent.

Based on the information obtained, there is sufficient evidence to support the licensee did not provide R1 prompt access to their medical records requested on 09/09/2022 as regulations do not support the need for an authorization of release of records be completed and states all residents are to have prompt access to review all of their records and to purchase photocopies of their records. Photocopied records shall be provided within two business days at a cost that does not exceed community standard for photocopies.
Therefore, the allegation of 'Administrator is not providing a former resident prompt access to receive a copy of their facility records' is deemed substantiated at this time.

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 and report reviewed with Administrator Ken Mahler. A copy of the report and appeal rights were emailed.
SUPERVISOR'S NAME: Desaree PereraTELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Kasandra LopezTELEPHONE: (818) 421-5183
LICENSING EVALUATOR SIGNATURE:

DATE: 09/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/29/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 29-AS-20220921104212
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: 09/29/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/03/2022
Section Cited
CCR
87468.2(a)(19)
1
2
3
4
5
6
7
87468.2 (a) (19)To have prompt access to review all of their records and to purchase photocopies of their records. Photocopied records shall be provided two (2) business days and at a cost that does not exceed the community standard for photocopies.
This requirement is not met as evidence by:
1
2
3
4
5
6
7
The administrator stated they will put in writing that they will be in compliance with regulation 87468.2 and also submit proof they have mailed R1's requested records to them. The plan of correction shall be submitted to CCL by 10/03/2022.
8
9
10
11
12
13
14
Based on interviews and record review, the licensee failed to comply with the section cited above, as R1 was not provided copies of their medical records requested within two business days of the request which poses an immediate personal rights violation.
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 PereraTELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Kasandra LopezTELEPHONE: (818) 421-5183
LICENSING EVALUATOR SIGNATURE:

DATE: 09/29/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/29/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 3