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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 565850112
Report Date: 01/28/2025
Date Signed: 01/28/2025 04:08:59 PM

Unsubstantiated


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: 92DATE:
01/28/2025
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Ken MahlerTIME COMPLETED:
04:10 PM
ALLEGATION(S):
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Unqualified facility staff are providing wound care to residents.
Facility staff are falsifying resident records.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Emily Peraldi conducted an unannounced subsequent complaint visit to this facility to deliver findings. At 09:30 a.m., the LPA met with Executive Director (ED) Ken Mahler and explained the reason for the visit.

During the initial visit conducted on 12/18/2024 between 10:00 a.m. and 3:15 p.m., LPA Peraldi conducted a physical plant tour and interviews with the ED, ten (10) residents, and three (3) staff. During the initial visit, the LPA also obtained copies of pertinent documents. During today’s visit, between 09:30 a.m. and 3:30 p.m., LPA Peraldi conducted a physical plant tour, reviewed records and conducted interviews with three (3) staff. Continued on LIC 9099-C.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kristin Heffernan
LICENSING EVALUATOR NAME: Emily Peraldi
LICENSING EVALUATOR SIGNATURE:

DATE: 01/28/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/28/2025
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 2
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: 01/28/2025
NARRATIVE
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Regarding the allegation: Unqualified facility staff are providing wound care to residents. On 12/11/2024, the Department received a complaint alleging Staff #1 (S1) of providing wound care to residents instead of calling hospice or home health agencies. Interviews conducted with the ED and S1 denied the allegation and stated that S1 does not provide wound care to residents. S1 stated that S1 provides first aid if needed, but that wound care is provided by outside agencies such as hospice or home health. Staff interviews conducted on 12/18/2024 and 01/28/2025 revealed that they do not do any wound care, only basic first aid. Staff interviews revealed that staff have not witnessed unqualified staff provide wound care to residents. The information obtained during the investigation did not include evidence sufficient to corroborate the allegation. Although the allegation may have happened or is valid, there is not sufficient evidence to prove the alleged violation did or did not occur, therefore the allegation is deemed Unsubstantiated at this time.

Regarding the allegation: Facility staff are falsifying resident records. Interview conducted with ED revealed that the ED has not witnessed staff falsify resident records. Staff interviews conducted on 12/18/2024 and 01/28/2025 revealed that staff have not been pressured to falsify resident records. Staff interviewed stated they have not witnessed staff falsify resident records. The information obtained during the investigation did not include evidence sufficient to corroborate the allegation. Although the allegation may have happened or is valid, there is not sufficient evidence to prove the alleged violation did or did not occur, therefore the allegation is deemed Unsubstantiated at this time.

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

DATE: 01/28/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/28/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2