565850112-6-20-2023-29-AS-DPEA-CT9VGA-20230629162513

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 565850112
Report Date: 06/20/2023
Date Signed: 06/20/2023 04:48:52 PM

Unsubstantiated

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
03/08/2023 and conducted by Evaluator Kasandra Lopez

COMPLAINT CONTROL NUMBER: 29-AS-20230308120104

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: 59	DATE:	06/20/2023
		UNANNOUNCED	TIME BEGAN:	10:27 AM
MET WITH:	Meshyll Filipinas		TIME COMPLETED:	05:00 PM

ALLEGATION(S):

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Staff are not assisting the resident with medications correctly
Resident did not receive medication timely
Staff does not treat resident with dignity and respect
Staff is not assisting resident with paying their bills

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) KaSandra Lopez conducted an unannounced subsequent complaint inspection at the facility regarding the above allegations. The LPA met with Wellness Director Meshyll Filipinas and explained the reason for the inspection.

This complaint investigation was initiated on 03/10/2023. During the 03/10/2023 inspection, the LPA conducted a physical plant tour, reviewed medications for Resident #1 (R1), interviewed the Administrator, and interviewed one staff between 11:19 AM-12:19 PM. R1 was not present in the facility to be interviewed on this day.

During today's inspection, the LPA conducted a physical plant tour beginning at 11:13 AM, conducted three resident interviews and five staff interviews between 11:16 AM and 3:31 PM. The LPA was advised that R1 no longer resides at the facility. Report continued on LIC 9099-C.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Desaree Perera	TELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Kasandra Lopez	TELEPHONE: (818) 421-5183
LICENSING EVALUATOR SIGNATURE:	DATE: 06/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2023

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-20230308120104

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: 06/20/2023

NARRATIVE

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Allegation: Staff are not assisting the resident with medications correctly

The allegation alleges staff are not giving R1 the correct medications and do not always give R1 all of their scheduled medication. During the 03/10/2023 inspection, the LPA reviewed medications and medication records for R1 and did not observe medication errors or discrepancies. Interviews with staff revealed no knowledge of R1 not receiving off their medications or any medication errors. Interviews with residents during today's inspection revealed no issues or concerns related to medications. Based on the information received, there is insufficient evidence to support the allegation occurred. Therefore, the allegation of Staff are not assisting the resident with medications correctly is deemed unsubstantiated at this time.

Allegation: Resident did not receive medication timely

The allegation alleges R1 was experiencing stomach pain and requested medication on or around 03/03/2023 but never received any medication. During the previous inspection, the LPA reviewed medication records, including the medication administration record, the Med Tech cross over notes, and resident notes for R1. The LPA did not observe any documentation to support a PRN medication was requested or administered for R1 on or around 03/03/2023. Interviews conducted with staff revealed no knowledge of R1 requesting a medication and it not being provided to R1. Interviews with residents during today's inspection revealed no issues or concerns related to medications. Based on the information received, there is insufficient evidence to support the allegation occurred. Therefore, the allegation of Resident did not receive medication timely is deemed unsubstantiated at this time.

Allegation: Staff does not treat resident with dignity and respect

The allegation alleges an unknown staff member went into R1's bedroom on or around 03/03/2023 and yelled at R1 and no one responded when R1 called for help. Record review revealed R1 had a history of being combative with staff, verbally abusive to staff, and would throw items at staff when upset. Interviews with staff revealed no knowledge or have witnessed any staff members yell at R1. Interviews with residents revealed no issues or concerns regarding how staff speak and interact with residents. Based on the information received, there is insufficient evidence to support the allegation occurred. Therefore, the allegation of Staff does not treat resident with dignity and respect is deemed unsubstantiated at this time.
Report continued on LIC 9099-C.

SUPERVISOR'S NAME: Desaree Perera	TELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Kasandra Lopez	TELEPHONE: (818) 421-5183
LICENSING EVALUATOR SIGNATURE:	DATE: 06/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2023

LIC9099 (FAS) - (06/04)

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Control Number 29-AS-20230308120104

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: 06/20/2023

NARRATIVE

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Allegation: Staff is not assisting resident with paying their bills

The allegation alleges R1 was having trouble managing their bills and staff were not assisting R1. During the interview with the Administrator on 03/10/2023, he stated R1 was independent and has never requested assistance with paying their bills. The Administrator stated they would speak with R1 and provide assistance as necessary for R1. Staff interviewed also stated R1 was independent and never expressed any concerns with paying their bills or requested any assistance. Based on the information obtained there is insufficient evidence to support the allegation occurred. Therefore, the allegation of Staff is not assisting resident with paying their bills is deemed unsubstantiated at this time.

Exit interview and report reviewed with the Wellness Director. A copy of the report and appeal rights were provided.

SUPERVISOR'S NAME: Desaree Perera	TELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Kasandra Lopez	TELEPHONE: (818) 421-5183
LICENSING EVALUATOR SIGNATURE:	DATE: 06/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/20/2023

LIC9099 (FAS) - (06/04)

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