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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306000059
Report Date: 02/24/2021
Date Signed: 02/24/2021 03:18:56 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME:PARK REGENCY RETIREMENT CENTERFACILITY NUMBER:
306000059
ADMINISTRATOR:JENNIFER TURGEONFACILITY TYPE:
740
ADDRESS:1750 W. LA HABRA BLVD.TELEPHONE:
(714) 441-1164
CITY:LA HABRASTATE: CAZIP CODE:
90631
CAPACITY:168CENSUS: 76DATE:
02/24/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
02:35 PM
MET WITH:Jennifer TurgeonTIME COMPLETED:
03:15 PM
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Licensing Program Analyst (LPA) Sean Haddad conducted an unannounced Case Management tele-visit for the purpose of following up on a Death Report received in the Orange County Regional Office on 2/22/21 regarding Resident #1 (R1). LPA met with Administrator (AD) Jennifer Turgeon and discussed purpose of the tele-visit.

During the visit, LPA interviewed AD and Staff #1 (S1), toured the facility, inspected R1's room, and requested copies of pertinent documents, R1's resident file, the resident roster, and the staff roster.

There were no health and safety concerns observed in the areas inspected. Based on the observations made during today’s visit, no deficiencies are being cited per Title 22 of the California Code of Regulations.

An exit interview was conducted with AD. This report along with the LIC811 will be emailed and an electronic email read receipt confirms receipt of the report. AD agrees to sign the report and email it back to LPA.
SUPERVISOR'S NAME: Marina StanicTELEPHONE: (714) 703-2851
LICENSING EVALUATOR NAME: Sean HaddadTELEPHONE: (714) 335-7094
LICENSING EVALUATOR SIGNATURE:

DATE: 02/24/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/24/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
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