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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306000059
Report Date: 05/05/2025
Date Signed: 05/05/2025 04:30:34 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
02/18/2025 and conducted by Evaluator Sean Haddad
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20250218110455
FACILITY NAME:PARK REGENCY RETIREMENT CENTERFACILITY NUMBER:
306000059
ADMINISTRATOR:ASHLEY WILLETTFACILITY TYPE:
740
ADDRESS:1750 W. LA HABRA BLVD.TELEPHONE:
(714) 441-1164
CITY:LA HABRASTATE: CAZIP CODE:
90631
CAPACITY:168CENSUS: 109DATE:
05/05/2025
UNANNOUNCEDTIME BEGAN:
07:40 AM
MET WITH:Ashley WillettTIME COMPLETED:
04:45 PM
ALLEGATION(S):
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Facility is in disrepair
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 allegation. LPA met with Administrator (AD) Ashley Willett and explained the reason for today’s inspection.

The investigation into the allegation that facility is in disrepair revealed the following: During the course of the investigation, LPA inspected the facility, interviewed AD, residents, and staff, and obtained and reviewed copies of the resident roster and staff roster.

CONTINUED
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Sean Haddad
LICENSING EVALUATOR SIGNATURE:

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

DATE: 05/05/2025
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 8
Control Number 22-AS-20250218110455
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		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 CENTER
FACILITY NUMBER: 306000059
VISIT DATE: 05/05/2025
NARRATIVE
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It was alleged that large ceiling leaks developed resulting in wet floors and other unsafe conditions and the facility did not properly address the leaks or communicate the situation to residents’ responsible parties. LPA interviewed AD and facility staff who stated that in February 2025 there was a leak that affected the first-floor hallway and nearby rooms, the situation was communicated to affected residents, measures were taken to mitigate the effects of the leak and ensure the health and safety of residents, and the leak was repaired as quickly as possible. LPA inspected the facility, including 14 resident rooms and all common areas, and observed that the damage from the leak has been repaired. LPA interviewed 11 residents and did not obtain information corroborating the allegation. However, LPA observed large stains under the bathroom sink, as well as water damage on the wall behind the toilet, in one resident room which appeared old and had not been repaired. The information obtained corroborated the allegation.

During the course of the investigation, the Department obtained sufficient evidence to substantiate the allegation mentioned above. The preponderance of evidence standard has been met; therefore, the above allegation is Substantiated. See LIC9099D for cited deficiencies per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted and a copy of this report and appeal rights was discussed with and provided to facility representative.
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Sean Haddad
LICENSING EVALUATOR SIGNATURE:

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

DATE: 05/05/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 8
Control Number 22-AS-20250218110455
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		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 CENTER
FACILITY NUMBER: 306000059
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/05/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/02/2025
Section Cited
CCR
87303(a)
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87303 Maintenance and Operation (a) The facility shall be clean, safe, sanitary and in good repair at all times… This requirement was not met as evidenced by:
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The licensee stated they will repair the bathroom and ensure there is no mold and submit proof to LPA by POC due date.
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Based on observation, the licensee did not ensure one resident’s bathroom was sanitary and in good repair when water damage was not repaired, which poses a potential health risk to persons in care.
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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: Armando J Lucero
LICENSING EVALUATOR NAME: Sean Haddad
LICENSING EVALUATOR SIGNATURE:

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

DATE: 05/05/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 8
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
02/18/2025 and conducted by Evaluator Sean Haddad
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20250218110455

FACILITY NAME:PARK REGENCY RETIREMENT CENTERFACILITY NUMBER:
306000059
ADMINISTRATOR:ASHLEY WILLETTFACILITY TYPE:
740
ADDRESS:1750 W. LA HABRA BLVD.TELEPHONE:
(714) 441-1164
CITY:LA HABRASTATE: CAZIP CODE:
90631
CAPACITY:168CENSUS: 109DATE:
05/05/2025
UNANNOUNCEDTIME BEGAN:
07:40 AM
MET WITH:Ashley WillettTIME COMPLETED:
04:45 PM
ALLEGATION(S):
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Staff did not keep the facility free of mold
Staff did not take precautions to prevent the spread of illness
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 Administrator (AD) Ashley Willett and explained the reason for today’s inspection.

The investigation into the allegations that staff did not keep the facility free of mold and staff did not take precautions to prevent the spread of illness revealed the following: During the course of the investigation, LPA inspected the facility, interviewed AD, residents, and staff, and obtained and reviewed copies of the resident roster, staff roster, facility incident reports, the facility’s infection control plan, and the facility’s communications with local public health.

CONTINUED
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Sean Haddad
LICENSING EVALUATOR SIGNATURE:

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

DATE: 05/05/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 8
Control Number 22-AS-20250218110455
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		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 CENTER
FACILITY NUMBER: 306000059
VISIT DATE: 05/05/2025
NARRATIVE
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Regarding the allegation that staff did not keep the facility free of mold: it was alleged that large ceiling leaks developed in the first-floor hallway near the dining room and in the second-floor memory care resulting in wet ceilings and mold and the facility did not properly address the mold. LPA interviewed AD and facility staff who stated that in February 2025 there was a leak that affected the first-floor hallway and nearby rooms, the leak was addressed as quickly as possible, the leak did not result in mold, facility staff tested affected rooms for mold and the results were negative, and the leak and ceiling were repaired and the carpets were changed to ensure no mold developed. LPA inspected the facility, including 14 resident rooms and all common areas, and did not observe evidence of mold. LPA interviewed 11 residents and did not obtain information corroborating the allegation. However, LPA observed large stains under the bathroom sink in one resident room as well as water damage on the wall behind the toilet which could possibly be mold. Per facility staff, this water damage has not yet been tested but is going to be repaired soon. The information obtained is conflicting.

Regarding the allegation that staff did not take precautions to prevent the spread of illness: it was alleged that there was a large infectious disease outbreak, and the facility did not properly address the outbreak or report the situation to residents’ responsible parties. LPA reviewed facility incident reports dated December 19, 2024, and December 23, 2024, which indicate 11 residents developed gastrointestinal symptoms, the outbreak was reported to local public health, and the facility was following the infection control guidance provided by local public health. LPA reviewed the facility’s infection control plan and noted it to be complete and current. LPA interviewed AD and facility staff who stated the gastrointestinal outbreak affected a total of 15 residents, facility staff reported the outbreak to local public health and followed the infection control guidance they received, facility staff notified the families of all residents, the outbreak ended on January 1, 2025, and no residents were hospitalized because of the outbreak. LPA reviewed the facility’s communications with local public health which show the facility notified local public health of the outbreak and received guidance on infection control protocols. LPA inspected the facility and observed sufficient supplies of masks, gloves, sanitizer, and gowns and also observed staff wearing personal protective equipment (PPE) while providing care to residents. Out of the 11 residents interviewed, some recalled seeing staff take infection control precautions during this outbreak, while many were unable to say. The information obtained did not corroborate the allegation.
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Sean Haddad
LICENSING EVALUATOR SIGNATURE:

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

DATE: 05/05/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 8
Control Number 22-AS-20250218110455
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		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 CENTER
FACILITY NUMBER: 306000059
VISIT DATE: 05/05/2025
NARRATIVE
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Based on the information gathered during the investigation and review of all documents obtained, the Department is unable to ascertain if the above allegations occurred as reported. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove or refute the alleged violations occurred; therefore, these allegations are deemed Unsubstantiated. An exit interview was conducted and a copy of this report was discussed with and provided to facility representative.
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Sean Haddad
LICENSING EVALUATOR SIGNATURE:

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

DATE: 05/05/2025
LIC9099 (FAS) - (06/04)
Page: 6 of 8
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
02/18/2025 and conducted by Evaluator Sean Haddad
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20250218110455

FACILITY NAME:PARK REGENCY RETIREMENT CENTERFACILITY NUMBER:
306000059
ADMINISTRATOR:ASHLEY WILLETTFACILITY TYPE:
740
ADDRESS:1750 W. LA HABRA BLVD.TELEPHONE:
(714) 441-1164
CITY:LA HABRASTATE: CAZIP CODE:
90631
CAPACITY:168CENSUS: 109DATE:
05/05/2025
UNANNOUNCEDTIME BEGAN:
07:40 AM
MET WITH:Ashley WillettTIME COMPLETED:
04:45 PM
ALLEGATION(S):
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Staff are not adequately trained
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 allegation. LPA met with Administrator (AD) Ashley Willett and explained the reason for today’s inspection.

The investigation into the allegation that staff are not adequately trained revealed the following: During the course of the investigation, LPA inspected the facility, interviewed AD and staff, and obtained and reviewed copies of the resident roster, staff roster, AD’s administrator certificate, and staff training records.

CONTINUED
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Sean Haddad
LICENSING EVALUATOR SIGNATURE:

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

DATE: 05/05/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 7 of 8
Control Number 22-AS-20250218110455
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		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 CENTER
FACILITY NUMBER: 306000059
VISIT DATE: 05/05/2025
NARRATIVE
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It was alleged that, in late December 2024, there was a large infectious disease outbreak which was not handled properly because AD and facility staff are not properly trained. LPA interviewed AD and facility staff who stated the gastrointestinal outbreak affected a total of 15 residents, facility staff reported the outbreak to local public health and followed the infection control guidance they received, facility staff notified the families of all residents, the outbreak ended on January 1, 2025, and no residents were hospitalized because of the outbreak. LPA reviewed AD’s administrator certificate which is current and indicates that AD’s administrator training is current. LPA reviewed the training records for five staff and confirmed they have completed the required caregiver annual training. Per AD and facility staff, staff are trained on infection control as part of their training. LPA reviewed staff training records dated December 18, 2024, which show staff were trained on gastrointestinal infections as part of the facility’s response to this outbreak. LPA did not obtain any information corroborating this allegation.

The Department has investigated the above allegation and found it to be Unfounded, meaning the allegation was false, could not have happened, or is without reasonable basis. An exit interview was conducted and a copy of this report was discussed with and provided to facility representative.
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Sean Haddad
LICENSING EVALUATOR SIGNATURE:

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

DATE: 05/05/2025
LIC9099 (FAS) - (06/04)
Page: 8 of 8