<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306000059
Report Date: 06/18/2025
Date Signed: 06/18/2025 12:14:46 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
06/12/2025 and conducted by Evaluator Sean Haddad
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20250612145141
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: 105DATE:
06/18/2025
UNANNOUNCEDTIME BEGAN:
07:32 AM
MET WITH:Miles MouradianTIME COMPLETED:
12:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility staff are not dispensing medication as prescribed
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
This unannounced inspection is being conducted by Licensing Program Analyst (LPA) Sean Haddad for the purpose of investigating the above-mentioned complaint allegation. LPA met with Pending Administrator (PA) Miles Mouradian, discussed the purpose of the inspection, and explained the allegation.

The investigation into the allegation that facility staff are not dispensing medication as prescribed revealed the following: During the course of the investigation, LPA inspected the facility, interviewed PA and staff, and obtained and reviewed copies of the resident roster, staff roster, and the facility’s Medication Administration Records.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Sean Haddad
LICENSING EVALUATOR SIGNATURE:

DATE: 06/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/18/2025
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 3
Control Number 22-AS-20250612145141
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: 06/18/2025
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
It was alleged that facility staff are not dispensing medications as prescribed. LPA inspected the facility, conducted health and safety checks on residents, and observed no health and safety issues. LPA interviewed PA and three staff and one staff admitted that Resident #1’s (R1) Fosfomycin, which is to be administered every three days to prevent urinary tract infections, was not given as prescribed, as there are still medications from the April 2025 shipment that remain, and the facility did not order a May 2025 supply. LPA inspected R1’s Fosfomycin and confirmed that five doses from the April 21, 2025, shipment, which should have been given to R1, are still present at the facility. LPA reviewed R1’s Medication Administration Records and noted that this medication is document as having been properly given to R1, which is incorrect. Facility staff were unable to provide an explanation as to why R1’s Fosfomycin was not given as prescribed or why it was documented as having been properly given, but stated the situation is being investigated. LPA inspected the Medication Administration Records for five additional residents and noted that Resident #2 (R2) did not receive any of their medications on May 1, 2025 due to lack of supply. Facility staff were unable to provide documentation of their attempts to follow up with R2’s doctor and pharmacy to ensure R2’s medications were delivered timely. 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: 06/18/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/18/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 22-AS-20250612145141
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: 06/18/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/19/2025
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
The licensee stated they will notify these residents’ doctors of these medication errors, retrain staff on assisting residents with medications, and submit proof to LPA by POC due date.
8
9
10
11
12
13
14
Based on documents and interviews, the licensee did not ensure R1 received one medication for multiple days and R2 received all of their medications for one day, which poses an immediate health risk to persons in care.
8
9
10
11
12
13
14
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
1
2
3
4
5
6
7
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: 06/18/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/18/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3