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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 565850112
Report Date: 03/26/2026
Date Signed: 03/26/2026 04:46:28 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
03/25/2026 and conducted by Evaluator Emily Peraldi
COMPLAINT CONTROL NUMBER: 29-AS-20260325153239
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:
03/26/2026
UNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Stephani SmithTIME COMPLETED:
04:50 PM
ALLEGATION(S):
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Staff did not assist resident(s) with self-administration of 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 1:00 p.m., the LPA met with the Interim Executive Director (ED) Stephani Smith and explained the reason for the visit.

During today’s visit starting at 1:36 p.m., the LPAs conducted a physical plant tour and interviewed the Interim ED, and five (5) staff. At 2:03 p.m., the LPA reviewed and obtained copies of pertinent documents during the visit.

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

DATE: 03/26/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/26/2026
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 3
Control Number 29-AS-20260325153239
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: 03/26/2026
NARRATIVE
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Regarding the allegation: Staff did not assist resident(s) with self-administration of medications as prescribed. It was alleged that Resident #1 (R1) was not receiving their medication of Vesicare, 5mg tablet (take 1 tab every day) as prescribed by physician. Per record review, R1’s Vesicare 5mg tablet is not documented on R1’s current centrally stored medication and destruction record (CSMDR). Additionally, on 03/11/2026 LPA Peraldi audited R1’s medications and did not observe Vesicare 5mg tablet in R1’s medication. On 03/11/2026, LPA Peraldi reviewed R1’s CSMDR and Vesicare 5mg tablet was not documented. The LPA was unable to determine when R1 was first prescribed Vesicare 5mg tablet, however R1 was not given Vesicare 5mg tablet until 03/19/2026. Based on observation and record review, the preponderance of evidence standard has been met, therefore the above allegation, “Staff did not assist resident(s) with self-administration of 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). Civil Penalty issued for the amount of $250. The Interim ED was informed that failure to correct deficiency may result in additional civil penalties.

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: 03/26/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/26/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 29-AS-20260325153239
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: 03/26/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
03/30/2026
Section Cited
CCR
87465(a)(4)
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87465(a)(4) Incidental Medical&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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Pharmacy will audit medications, as well at the Interim ED. The Interim ED will send proof of audit.
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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 self-administered 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: 03/26/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/26/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 3