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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 565850112
Report Date: 12/18/2024
Date Signed: 12/18/2024 03:09:54 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 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
12/11/2024 and conducted by Evaluator Emily Peraldi
COMPLAINT CONTROL NUMBER: 29-AS-20241211134457
FACILITY NAME:REGENCY PALMS OXNARDFACILITY NUMBER:
565850112
ADMINISTRATOR:KENNETH MAHLERFACILITY TYPE:
740
ADDRESS:1020 BISMARK WAYTELEPHONE:
(805) 247-0227
CITY:OXNARDSTATE: CAZIP CODE:
93033
CAPACITY:127CENSUS: 93DATE:
12/18/2024
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Ken MahlerTIME COMPLETED:
03:15 PM
ALLEGATION(S):
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Facility staff do not dispense medications as prescribed.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Emily Peraldi conducted an unannounced initial complaint visit to this facility. At 10:00 a.m., the LPA met with Executive Director (ED), Ken Mahler, and explained the reason for the visit.

At 10:05 a.m., the LPA conducted an interview with the ED. Between 10:36 a.m. and 1:30 p.m., the LPA conducted a review of medication and medication documentation with staff for ten (10) residents. Starting at 10:22 a.m., the LPA conducted interviews with three (3) staff. At 1:44 p.m., the LPA requested and obtained copies of pertinent documents. At 2:45 p.m., the LPA, along with the ED conducted a physical plant tour.

Continued on LIC 9099-C.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Emily Peraldi
LICENSING EVALUATOR SIGNATURE:

DATE: 12/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/18/2024
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 4
Control Number 29-AS-20241211134457
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: REGENCY PALMS OXNARD
FACILITY NUMBER: 565850112
VISIT DATE: 12/18/2024
NARRATIVE
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Regarding the allegation: Facility staff do not dispense medications as prescribed. On 12/11/2024, the Department received a complaint alleging staff not dispensing medications as prescribed. During today’s visit, between 10:36 a.m. and 1:30 p.m., the LPA conducted a review of medication and medication documentation with staff for ten (10) residents and observed the following: Resident #1 (R1’s) Bedtime Senna 8.6 MG tablet had 22 tablets remaining, however the medication was started on 11/28/2024 and with the quantity listed as 60, meaning there should be a total of 20 tablets remaining instead. R1’s Noon Carbidopa-Levodopa 25-100 Tab had 16.5 tablets remaining, however the medication started on 11/28/2024 and with the quantity listed as 45, meaning there should be a total of 15 tablets remaining. Resident #2’s (R2’s) Bedtime Eliquis 2.5 MG tablet had 11 tablets remaining, however the medication was started on 11/28/2024 and with the quantity listed as 30, meaning there should be 10 tablets remaining. R2’s Bedtime Atorvastatin 20 MG Tablet had 9 tablets remaining, however the medication was started on 11/26/2024 and with the quantity listed as 30, meaning there should be 8 tablets remaining. Resident #3’s (R3’s) AM Levothyroxine 50 MCG tablet had 13 tablets remaining, however the medication was started on 12/01/2024 and with the quantity listed as 30, meaning there should be 12 tablets remaining. Resident #4’s (R4’s) Bedtime Donepezil HCL 5 MG tablet had 14 tablets remaining, however the medication was started on 11/30/2024 and with the quantity listed as 30, meaning there should be 12 tablets remaining. Based on observation and record review, the preponderance of evidence standard has been met, therefore the above allegation, “Facility staff do not dispense medications as prescribed” is deemed Substantiated at this time.

Per the California Code of Regulations, Title 22, Division 6, Chapter 8, the following deficiency was observed and cited during the visit (See 9099-D).

Exit interview conducted. A copy of the report and appeal rights were provided.
SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Emily Peraldi
LICENSING EVALUATOR SIGNATURE:

DATE: 12/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/18/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 29-AS-20241211134457
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: REGENCY PALMS OXNARD
FACILITY NUMBER: 565850112
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/18/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
12/19/2024
Section Cited
CCR
87465(a)(4)
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87465(a)(4) Incidental Medical and Dental Care. (a) A plan for incidental medical and dental care shall be developed by each facility…(4) The licensee shall assist residents with self-administered medications as needed. This requirement is not met as evidenced by:
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Within 24 hours, the Administrator will notify the LPA when medication training will be completed. Administrator stated a medication audit for the facility and training for all medication staff and submit documentation to CCL by 12/31/2024.
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Based on record review and observations, the licensee did not comply with the section cited above, as the facility staff did not properly assist with R1’s, R2’s, R3’s and R4’s self-administered medications per physician’s order which poses an immediate 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.
SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Emily Peraldi
LICENSING EVALUATOR SIGNATURE:

DATE: 12/18/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/18/2024
LIC9099 (FAS) - (06/04)
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