565850112-4-19-2022-29-AS-DPEA-CW5VL4-20230929163118

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 565850112
Report Date: 04/19/2022
Date Signed: 04/19/2022 04:25:49 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
04/08/2022 and conducted by Evaluator Kasandra Lopez

COMPLAINT CONTROL NUMBER: 29-AS-20220408113452

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: 56	DATE:	04/19/2022
		UNANNOUNCED	TIME BEGAN:	01:36 PM
MET WITH:	Ken Mahler		TIME COMPLETED:	03:30 PM

ALLEGATION(S):

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Facility signal system is in disrepair

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) KaSandra Lopez conducted an unannounced subsequent complaint investigation inspection at the facility today regarding the above allegation. The LPA met with Administrator Ken Mahler at 1:36 PM and explained the reason today's inspection.

During today's inspection, the LPA along with the Administrator, checked the pendants and pull cord signal systems in apartments 125, 148, and 150 between 1:45 PM and 1:52 PM and the pendant and pull cords signal systems in apartments 106 and 158 between 2:29 PM and 2:33 PM. During today's inspection the LPA also conducted interviews with three staff members between 1:56 PM and 2:42 PM. During the previous inspection on 04/14/2022, the LPA and Administrator also tested the pendant and pull cord signal system for apartment 125.

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: 04/19/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/19/2022

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-20220408113452

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: 04/19/2022

NARRATIVE

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The allegation of 'Facility signal system is in disrepair' alleges the pendant or pull cords do not function when pulled or pressed. During today's inspection and during the previous inspection, the LPA along with the Administrator tested the pendants and pull cords in the bedrooms and bathrooms of five apartments. The LPA observed the pager staff carries to be alerted immediately once the button was pushed or the cord was pulled. Staff interviewed during the 04/14/2022 inspection and during today's inspection did not report any issues with the signal system not working properly. The Administrator was also not aware of the signal system being down or not functioning properly. Based on the information obtained, there is insufficient evidence to support the allegation occurred. Therefore, the allegation of 'Facility signal system is in disrepair' is deemed unsubstantiated at this time.

Exit interview and report reviewed with the Administrator. A copy of the report and appeal rights will be emailed.

SUPERVISOR'S NAME: Desaree Perera	TELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Kasandra Lopez	TELEPHONE: (818) 421-5183
LICENSING EVALUATOR SIGNATURE:	DATE: 04/19/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/19/2022

LIC9099 (FAS) - (06/04)

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