306000059-5-12-2026-22-AS-APAO-DU4Q65-20260515115258

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306000059
Report Date: 05/12/2026
Date Signed: 05/12/2026 03:28:46 PM

Substantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/23/2022 and conducted by Evaluator Sean Haddad

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20220323083918

FACILITY NAME:	PARK REGENCY RETIREMENT CENTER		FACILITY NUMBER:	306000059
ADMINISTRATOR:	ROSALIE SULLIVAN		FACILITY TYPE:	740
ADDRESS:	1750 W. LA HABRA BLVD.		TELEPHONE:	(714) 441-1164
CITY:	LA HABRA	STATE: CA	ZIP CODE:	90631
CAPACITY:	168	CENSUS: 100	DATE:	05/12/2026
		UNANNOUNCED	TIME BEGAN:	07:31 AM
MET WITH:	Maria Vasquez		TIME COMPLETED:	02:00 PM

ALLEGATION(S):

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Staff did not provide proper medication assistance to resident in care
Resident's call button was in disrepair
Facility did not maintain grab bars for each resident toilet
Staff did not complete a reappraisal on resident in care

INVESTIGATION FINDINGS:

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This unannounced inspection is being conducted by Licensing Program Analyst (LPA) Sean Haddad for the purpose of delivering findings for the investigation into the above identified complaint allegations. LPA met with Wellness Director (WD) Maria Vasquez and explained the reason for today’s inspection.

The investigation into the allegations that staff did not provide proper medication assistance to resident in care, resident's call button was in disrepair, facility did not maintain grab bars for each resident toilet, and staff did not complete a reappraisal on resident in care revealed the following: During the course of the investigation, LPA inspected the facility, interviewed staff and residents, and obtained and reviewed copies of the resident roster, staff roster, Resident #1’s (R1) care notes, R1’s Medication Administration Records (MAR), the facility’s internal communications, and a copy of R1’s service plan marked up on January 6, 2022.

Substantiated

Estimated Days of Completion:

SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Sean Haddad
LICENSING EVALUATOR SIGNATURE:	DATE: 05/12/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/12/2026

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 7

Control Number 22-AS-20220323083918

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: PARK REGENCY RETIREMENT CENTER	FACILITY NUMBER: 306000059
	VISIT DATE: 05/12/2026

NARRATIVE

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Regarding the allegation that staff did not provide proper medication assistance to resident in care: it was alleged that R1 did not take their medication because staff would leave R1’s room without confirming they took the medication. LPA inspected the facility, conducted health and safety checks on residents, and observed no health and safety issues. LPA interviewed five residents and did not obtain information corroborating that medication technicians leave residents’ rooms without confirming residents have taken their medication. However, LPA reviewed R1’s care notes which indicate on May 12, 2021, a reminder was documented for the medication technicians emphasizing the importance of staying in the room and watching R1 drink a liquid medication, advising that R1 missing doses of this medication will alter R1’s potassium levels, and advising that on May 12, 2021 R1’s family reported that R1’s dialysis nurse found R1’s potassium levels to be dangerously high. In addition, LPA reviewed R1’s MAR which indicates R1’s Sevelamer Carbonate 800MG was not documented as being given for the noon dose on January 24, 2022.

Regarding the allegation that a resident's call button was in disrepair: it was alleged that R1’s call button was not functioning for three weeks in January 2022. LPA reviewed the facility’s internal communications which document that the entire call system stopped functioning on February 16, 2022, and checks were conducted on all residents in lieu of the call system. However, per the facility’s’ internal communications, on February 17, 2022, a caregiver checked on R1, R1 complained that they had been calling for assistance, but the caregiver documented that the call light system was still not working and they had only checked on R1 because of their rounding. R1’s care notes and the facility’s internal communications do not document any issues with the call button system after February 17, 2022. Facility staff were supposed to conduct regular checks on residents while the call system was not working, but the information obtained shows that R1 was calling for assistance for an unknown length of time, the caregiver did not receive the signal or respond timely, and the caregiver only checked on R1 as part of their last check without realizing R1 had been calling for assistance.

Regarding the allegation that facility did not maintain grab bars for each resident toilet: it was alleged that R1’s room did not have grab bars for the toilet and staff did not correct the issue. Per the facility’s resident roster and R1’s MAR, R1 resided in Room 165. LPA interviewed the facility’s maintenance director who stated there are two styles of bathrooms, where the old style has a sink that goes up to the toilet and the sink can be used as a grab bar, and the new style where the sink is far from the toilet and cannot be used as a grab bar. Per the facility’s maintenance director, grab bars are installed when requested by residents’ families.

SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Sean Haddad
LICENSING EVALUATOR SIGNATURE:	DATE: 05/12/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/12/2026

LIC9099 (FAS) - (06/04)

Page: 2 of 7

Control Number 22-AS-20220323083918

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: PARK REGENCY RETIREMENT CENTER	FACILITY NUMBER: 306000059
	VISIT DATE: 05/12/2026

NARRATIVE

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LPA inspected the facility and confirmed that the old style has a sink that goes up to the toilet and could possibly be used as a grab bar, but Room 165 does not have separate grab bar installed on the sink and the edge of the sink does not provide the same gripping surface as a true grab bar, meaning it does not meet the requirement that every toilet have a grab bar. In addition, LPA noted room 206 has the new style where the sink does not reach the toilet and there is no grab bar installed on the toilet.

Regarding the allegation that staff did not complete a reappraisal on resident in care: it was alleged that in January 2022, R1 had a fall resulting in decreased arm mobility and the facility did not conduct a reappraisal or update R1’s care plan prior to R1 leaving the facility in February 2022. LPA reviewed R1’s care notes which document that on December 15, 2021, R1 had a fall, went to the hospital, and was picked up by their family to stay with their family. Per R1’s MAR, R1 returned to the facility on January 6, 2022. LPA reviewed R1’s care notes which document that on December 22, 2021, facility staff communicated with R1’s family regarding R1’s change of condition after their fall and documented R1’s new care needs and how they would be met. LPA reviewed a copy of R1’s service plan marked up on January 6, 2022 by the facility’s wellness director at the time that documents R1’s new care needs and documents that the facility would use a wheelchair for R1, but this document was never finalized. Per R1’s care notes, when R1 returned to the facility on January 6, 2022, facility staff requested an updated physician’s report from R1’ doctor and planned to update R1’s service plan. R1’s care notes document that on February 18, 2022, a care plan meeting was held with R1’s family, it was explained to R1’s family that R1’s service plan had not yet been updated because the facility was still waiting on an updated physician’s report from R1’s doctor, R1’s family was advised that staff are all aware of R1’s new care needs and the required care was being provided, and R1’s family advised the facility that R1 would be moving out. While the facility noted R1’s new care level and claimed to provide the newly required services, the facility did not need to wait for the new physician’s report in order to finalize the changes already discussed with R1’s family. In this case, R1 returned to the facility on January 6, 2022 and did not have a finalized updated service plan by the time they moved out on February 19, 2022.
During the course of the investigation, the Department obtained sufficient evidence to substantiate the allegations mentioned above. The preponderance of evidence standard has been met; therefore, the above allegations are Substantiated. See LIC9099D for cited deficiencies per Title 22 Division 6 of the California Code of Regulations. Civil penalties for repeat violations are being assessed. See LIC421FC. An exit interview was conducted and a copy of this report and appeal rights was discussed with and provided to facility representative.

SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Sean Haddad
LICENSING EVALUATOR SIGNATURE:	DATE: 05/12/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/12/2026

LIC9099 (FAS) - (06/04)

Page: 3 of 7

Control Number 22-AS-20220323083918

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: PARK REGENCY RETIREMENT CENTER	FACILITY NUMBER: 306000059
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 05/12/2026

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 06/09/2026 Section Cited CCR 87465(a)(4)	1 2 3 4 5 6 7	87465 Incidental Medical and Dental Care (a) … (4) The licensee shall assist residents with self-administered medications as needed. This requirement was not met as evidenced by:	1 2 3 4 5 6 7	Licensee stated they will conduct medication training and submit proof to LPA by POC due date.
	8 9 10 11 12 13 14	Based on documents, the licensee did not ensure R1 received assistance with medications when their dose of Sevelamer Carbonate was not documented as administered, which poses a potential health risk to persons in care. CIVIL PENALTY ASSESSED	8 9 10 11 12 13 14
Type B 06/09/2026 Section Cited CCR 87303(i)(1)(A)	1 2 3 4 5 6 7	87303(i)(1)(A) – 87303 Maintenance and Operation (i) Facilities shall have signal systems which … (1) … (A) Operate from each resident's living unit... This requirement was not met as evidenced by:	1 2 3 4 5 6 7	Licensee stated they will create a protocol for regular checks if the signal system malfunctions, train staff on the protocol, and submit the protocol and training records to LPA by POC due date.
	8 9 10 11 12 13 14	Based on documents, the licensee’s signal system malfunctioned, staff were supposed to conduct regular checks, but R1’s attempts to call staff went unanswered until a caregiver happened to check on R1, which poses a potential safety risk to persons in care.	8 9 10 11 12 13 14

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: Lourdes Montoya
LICENSING EVALUATOR NAME: Sean Haddad
LICENSING EVALUATOR SIGNATURE:	DATE: 05/12/2026

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/12/2026

LIC9099 (FAS) - (06/04)

Page: 4 of 7

Control Number 22-AS-20220323083918

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: PARK REGENCY RETIREMENT CENTER	FACILITY NUMBER: 306000059
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 05/12/2026

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 06/09/2026 Section Cited CCR 87303(e)(4)	1 2 3 4 5 6 7	87303 Maintenance and Operation … (e) … (4) Grab bars shall be maintained for each toilet; bathtub and shower used by residents. This requirement was not met as evidenced by:	1 2 3 4 5 6 7	Licensee stated they will create a list of all rooms without grab bars for the toilet, install grab bars in all these rooms, and submit proof to LPA by POC due date.
	8 9 10 11 12 13 14	Based on admission and observation, the licensee did not ensure multiple rooms, including Rooms 165 and 206, have grab bars for the toilet, which poses a potential safety risk to persons in care.	8 9 10 11 12 13 14
Type B 06/09/2026 Section Cited CCR 87463(a)	1 2 3 4 5 6 7	87463 Reappraisals (a) The pre-admission appraisal … shall be updated in writing as frequently as necessary … to note significant changes in condition … and to keep the appraisal accurate…. This requirement was not met as evidenced by:	1 2 3 4 5 6 7	Licensee stated they will create a protocol to ensure residents are reappraised timely and submit proof to LPA by POC due date.
	8 9 10 11 12 13 14	Based on admission, the licensee started, but did not complete, a reappraisal for R1 based on their change of condition, which poses a potential safety risk to persons in care. CIVIL PENALTY ASSESSED	8 9 10 11 12 13 14

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: Lourdes Montoya
LICENSING EVALUATOR NAME: Sean Haddad
LICENSING EVALUATOR SIGNATURE:	DATE: 05/12/2026

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/12/2026

LIC9099 (FAS) - (06/04)

Page: 5 of 7

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/23/2022 and conducted by Evaluator Sean Haddad

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20220323083918

FACILITY NAME:	PARK REGENCY RETIREMENT CENTER		FACILITY NUMBER:	306000059
ADMINISTRATOR:	ROSALIE SULLIVAN		FACILITY TYPE:	740
ADDRESS:	1750 W. LA HABRA BLVD.		TELEPHONE:	(714) 441-1164
CITY:	LA HABRA	STATE: CA	ZIP CODE:	90631
CAPACITY:	168	CENSUS: 100	DATE:	05/12/2026
		UNANNOUNCED	TIME BEGAN:	07:31 AM
MET WITH:	Maria Vasquez		TIME COMPLETED:	02:00 PM

ALLEGATION(S):

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Staff did not assist resident in a timely manner

INVESTIGATION FINDINGS:

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Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Sean Haddad
LICENSING EVALUATOR SIGNATURE:	DATE: 05/12/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/12/2026

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 6 of 7

Control Number 22-AS-20220323083918

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: PARK REGENCY RETIREMENT CENTER	FACILITY NUMBER: 306000059
	VISIT DATE: 05/12/2026

NARRATIVE

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It was alleged that when R1’s call button did function, R1 had to wait 30 minutes or longer for assistance from staff. LPA interviewed the administrator at the time who stated the average wait time is five to 10 minutes, with the old call button system wait times could not be tracked, but with the pendant system installed on March 1, 2022, they can now track wait times. LPA interviewed five residents and did not obtain information corroborating long wait times. LPA reviewed the facility’s internal communications which document that on February 9, 2022, R1 called for assistance at 5:08AM, requested a medication from the caregiver, and the medication was provided to R1 by the medication technician at 5:20AM. The facility’s internal communications also document that on January 21, 2022, at 5:40AM, R1 requested assistance, assistance was provided by a caregiver, and the encounter was completed and documented by the medication technician minutes later at 5:53AM. These incidents demonstrate rapid response times by staff. Per the facility’s internal communications, on February 11, 2022, R1 requested assistance at 3:08AM, stated they were hungry and wanted the medication technician to warm up the soup in their fridge and feed them, the medication technician advised R1 that they could not because they had to attend to other residents, and the medication technician went back and confirmed R1 was fine prior to 5:36AM when the encounter was documented. This incident demonstrates that R1’s call was answered, R1’s request could not be immediately fulfilled, and the staff checked back later to ensure R1 was doing well, although additional details, including whether R1 withdrew their request to eat so early in the morning or when the staff made their second check, were not documented and the staff no longer works at the facility. The information obtained is conflicting.

Based on the information gathered during the investigation and review of all documents obtained, the Department is unable to ascertain if the above allegation occurred as reported. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove or refute the alleged violation occurred; therefore, this allegation is deemed Unsubstantiated. An exit interview was conducted and a copy of this report was discussed with and provided to facility representative.

SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Sean Haddad
LICENSING EVALUATOR SIGNATURE:	DATE: 05/12/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/12/2026

LIC9099 (FAS) - (06/04)

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