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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 565850112
Report Date: 05/15/2025
Date Signed: 05/15/2025 03:35:59 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
05/14/2025 and conducted by Evaluator Emily Peraldi
COMPLAINT CONTROL NUMBER: 29-AS-20250514081250
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: 89DATE:
05/15/2025
UNANNOUNCEDTIME BEGAN:
09:49 AM
MET WITH:Kenneth "Ken" MahlerTIME COMPLETED:
03:40 PM
ALLEGATION(S):
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Staff did not administer medication to a resident in care.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Emily Peraldi conducted an unannounced initial complaint visit to this facility. At 9:49 a.m., the LPA met with staff and explained the reason for the visit. At 10:00 a.m., the Executive Director (ED), Kenneth “Ken” Mahler met with the LPA.

At 10:00 a.m., the LPA conducted an interview with the ED. At 10:35 a.m., the LPA, along with the ED conducted a physical plant tour. Between 10:40 a.m. and 11:21 a.m., the LPA conducted a review of medication and medication documentation with staff for eight (8) residents. Starting at 10:51 a.m., the LPA conducted interviews with two (2) staff and two (2) residents. At 11:45 a.m., the LPA requested and obtained copies of pertinent documents. At 12:00 p.m., the LPA conducted a file review Resident #1 (R1’s) records.

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

DATE: 05/15/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/15/2025
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 4
Control Number 29-AS-20250514081250
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: 05/15/2025
NARRATIVE
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Regarding the allegation: Staff did not administer medication to a resident in care. On 05/14/2025, the Department received a complaint alleging staff not administering Resident #1’s (R1’s) morphine medication as prescribed. During today’s visit, the LPA reviewed R1’s records including but not limited to hospice documents, controlled drug record, and resident appraisal. R1 was admitted to hospice on 04/24/2025 with terminal diagnosis of Alzheimer’s disease. On 04/25/2025, R1 was prescribed through hospice Morphine Sulfate 20 mg/1mL Solution (0.25 ml dosage) for once a day. On 05/07/2025, R1 received a new physician order for Morphine Sulfate 20 mg/1mL Solution (0.25 ml dosage) to be given every six (6) hours. On 05/08/2025, R1 again received a new physician order for Morphine Sulfate 20 mg/1mL Solution (0.25 ml dosage) to be given every two (2) hours. Interview and record review revealed that R1’s Morphine Sulfate 20 mg/1 mL solution was in pre-filled syringes that were centrally stored. On 05/08/2025, per controlled drug record, R1 was last given Morphine Sulfate 20 mg/1mL Solution at 8:30 p.m. and staff did not again offer R1 the medication until the following morning, 05/09/2025 at 6 a.m. R1 was not given four (4) scheduled doses and staff did not properly assist R1 with self-administration of medication as prescribed. Based on record review, the preponderance of evidence standard has been met, therefore the above allegation, “Staff did not administer medication to a resident in care” 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). Civil Penalty issued for the amount of $250.

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: 05/15/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/15/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 29-AS-20250514081250
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: 05/15/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
05/16/2025
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 ED will notify the LPA when medication training will be completed.
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Based on record review, the licensee did not comply with the section cited above, as the facility staff did not properly assist R1’s medications per physician’s order which poses an immediate health and safety risk to residents in care.
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Civil Penalty issued for the amount of $250 for repeat violation.
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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: 05/15/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/15/2025
LIC9099 (FAS) - (06/04)
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