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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 565850112
Report Date: 07/12/2023
Date Signed: 07/12/2023 12:47:53 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
04/08/2022 and conducted by Evaluator Kasandra Lopez
COMPLAINT CONTROL NUMBER: 29-AS-20220408113452
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: 64DATE:
07/12/2023
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Ken MahlerTIME COMPLETED:
01:00 PM
ALLEGATION(S):
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Staff did not attend to resident in a timely manner
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 allegations. The LPA met with Administrator Ken Mahler at and explained the reason today's inspection.

On 04/14/2022 at 10:07 AM, LPA Lopez began the investigation and conducted an interview with the Administrator. At approximately 10:20 AM, the LPA reviewed facility records and obtained pertinent copies. Between 11:40 AM and 3:14 PM the LPA conducted interviews with six staff members and at 3:20 PM the LPA and Administrator tested the pull cord signal system and pendent for apartment 125 and both were observed to be operational.

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: 07/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/12/2023
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 6
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: 07/12/2023
NARRATIVE
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On 04/19/2022, a subsequent visit was conducted by the LPA. Between 1:45 PM and 2:33PM the pendent and pull cord system was tested in five apartments. Interviews with three staff members was also conducted between 1:56 PM and 2:42 PM. On 04/22/2022, the LPA obtained a copy of the 01/16/2022 Incident Detail Report from the Oxnard Fire Department. On 09/29/2022, the LPA conducted interviews with four residents between 11:38 AM and 12:30 PM.

Allegation: Staff did not attend to resident in a timely manner

The allegation alleges on 01/16/2022, Resident #1 (R1) fell in their apartment and staff did not respond to their pendent call request, so they called 911 for assistance getting up. A review of the 01/16/2022 Oxnard Fire Department Incident Detail Report revealed a call for service was received at on 01/16/2022 at 6:10 PM and the unit arrived at the facility at 6:15 PM. At 6:19 PM the fire department requested the reporting party to meet them in the alley to help gain access in the building, but the patient was unable to get up off the floor and staff had not responded to the resident’s attempts to contact them. The report states a 69 year old resident was found conscious and breath and the chief problem was the resident fell off of their bed. The resident was helped up to their bed and the call was closed at 6:27 PM.

Interviews with Staff #1 (S1) revealed they recalled one day around 5:00-6:00 PM, the fire department knocked on the memory care door. S1 stated there was only two staff on duty that day and they were assisting a resident in memory care. S1 said the fire department told S1 they were there because someone called 911. The fire department provided the room number and when they went to R1’s apartment they observed R1 sitting on the floor. R1 was helped up and did not need further medical assistance. S1 recalled the other caregiver had the pager for the pendent call requests that day. Facility record review of the med-tech cross over notes reports on 01/16/2022, R1 slipped but was fully aware with no pain.

Based on information received, there is sufficient evidence to support the allegation of staff did not attend to resident in a timely manner occurred. Therefore, the allegation is deemed substantiated at this time.

The following deficiency was cited from the CA Code of Regulations. See LIC 9099-D. Exit interview conducted and report reviewed with the Administrator. A copy of the report was provided.

SUPERVISOR'S NAME: Desaree PereraTELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Kasandra LopezTELEPHONE: (818) 421-5183
LICENSING EVALUATOR SIGNATURE:

DATE: 07/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/12/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 6
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 OXNARDFACILITY NUMBER:
565850112
ADMINISTRATOR:KENNETH MAHLERFACILITY TYPE:
740
ADDRESS:1020 BISMARK LANETELEPHONE:
(805) 247-0227
CITY:OXNARDSTATE: CAZIP CODE:
93033
CAPACITY:127CENSUS: DATE:
07/12/2023
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Ken MahlerTIME COMPLETED:
01:00 PM
ALLEGATION(S):
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Resident was given wrong medication dose
Staff spoke inappropriately to resident in care
Staff did not safeguard resident's personal belongings
INVESTIGATION FINDINGS:
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On 04/14/2022 at 10:07 AM, LPA Lopez began the investigation and conducted an interview with the Administrator. At approximately 10:20 AM, the LPA reviewed facility records and obtained pertinent copies. Between 11:40 AM and 3:14 PM the LPA conducted interviews with six staff members and at 3:20 PM the LPA and Administrator tested the pull cord signal system and pendent for apartment 125 and both were observed to be operational.

On 04/19/2022, a subsequent visit was conducted by the LPA. Between 1:45 PM and 2:33PM the pendent and pull cord system was tested in five apartments. Interviews with three staff members was also conducted between 1:56 PM and 2:42 PM. On 04/22/2022, the LPA obtained a copy of the 01/16/2022 Incident Detail Report from the Oxnard Fire Department. On 09/29/2022, the LPA conducted interviews with four residents between 11:38 AM and 12:30 PM.

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

DATE: 07/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/12/2023
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 6
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: 07/12/2023
NARRATIVE
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Allegation: Resident was given wrong medication dose

The allegation alleges Resident #1 (R1) received a higher dosage of medication Lamictal by staff which affected R1’s mobility and resulted in falls. Record review revealed a 12/16/2021 physician’s order for medication Lamictal 25 mg increasing the dosage weekly for five weeks. There was also an undated physician’s order tapering down R1’s Lamictal every five days until it’s discontinued in 15 days. Record review of the medication administered record for December 2021, January 2022, and February are unclear whether staff were following the order and the discontinued order as ordered because the order for the decrease of the medication is undated by the physician. There are also multiple documented refusals of the medication by R1 and interviews revealed R1 wanted to discontinue the medication. Staff interviewed were also unaware of any medication errors. Based on the information obtained, there is insufficient evidence to support the allegation of Resident was given wrong medication dose. Therefore, the allegation is deemed unsubstantiated at this time.

Allegation: Staff spoke inappropriately to resident in care

The allegation alleges Staff #2 (S2) yelled at R1 in the dining room to take their medication and the whole dining room heard, along with Staff #3 (S3). During the interview with S2, they denied ever yelling at R1 in the dining room and stated R1 was the one yelling at S2. S2 said in the dining room R1 yelled at S2 to get out of the dining room while they took their medications. Interviews with S3 revealed they recalled an incident in the dining room between S2 and R1 when R1 did not want S2 to stand there while R1 took their medication and was upset. S3 agreed to watch R1 take their medication to de-escalate the situation. S3 denied hearing S2 yell at R1. The allegation also alleges that Staff #4 (S4) was rude to R1. During the interview with S4 they denied ever being rude or talking inappropriately with R1. Residents and staff interviewed had no issues or concerns regarding how S2 and S4 treat the residents. Based on the information obtained, there is insufficient evidence to support the allegation of staff spoke inappropriately to resident in care. Therefore, the allegation is deemed unsubstantiated at this time.

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

DATE: 07/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/12/2023
LIC9099 (FAS) - (06/04)
Page: 4 of 6
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: 07/12/2023
NARRATIVE
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Allegation: Staff did not safeguard resident's personal belongings

The allegation alleges several of R1's clothing items were missing after S4 did R1's laundry. During the interview with S4 they stated they were not aware of R1 missing any clothing items after doing R1's laundry. Interviews with residents and staff revealed no issues or concerns regarding missing laundry. Based on the information obtained, there is insufficient evidence to support the allegation of staff did not safeguard resident's personal belongings occurred. Therefore, the allegation is deemed unsubstantiated at this time.

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

DATE: 07/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/12/2023
LIC9099 (FAS) - (06/04)
Page: 5 of 6
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/12/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/21/2023
Section Cited
CCR
87468.2(a)(4)
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87468.2 (a)(4) To care, supervision, and services that meet their individual needs and are delivered by staff that are sufficient in numbers, qualifications, and competency to meet their needs.
This requirement is not met as evidenced by:
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The Administrator will conduct an in-service regarding answering call lights promptly, have maintenance check all pendents and call lights to ensure they are working properly and conduct self audits monthly moving forward. Plan and copy of in-service shall be submitted to CCL by 07/21/2023.
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Based on interviews and record review, the licensee failed to comply with the section cited above as staff did not respond to R1's call for assistance and had to call 911 for them self to obtain assistance which poses a potential 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: Desaree PereraTELEPHONE: (818) 596-4347
LICENSING EVALUATOR NAME: Kasandra LopezTELEPHONE: (818) 421-5183
LICENSING EVALUATOR SIGNATURE:

DATE: 07/12/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/12/2023
LIC9099 (FAS) - (06/04)
Page: 6 of 6