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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306000059
Report Date: 03/16/2023
Date Signed: 03/16/2023 03:27:43 PM


Document Has Been Signed on 03/16/2023 03:27 PM - It Cannot Be Edited

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:ROSALIE SULLIVANFACILITY TYPE:
740
ADDRESS:1750 W. LA HABRA BLVD.TELEPHONE:
(714) 441-1164
CITY:LA HABRASTATE: CAZIP CODE:
90631
CAPACITY:168CENSUS: 99DATE:
03/16/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
02:15 PM
MET WITH:Justin CasemTIME COMPLETED:
03:40 PM
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This unannounced case management inspection is being conducted by Licensing Program Analyst (LPA) Sean Haddad for the purpose of following up on the status of the facility’s administrator. LPA met with Staff #1 (S1) Justin Casem and discussed the purpose of the inspection.

During the inspection, LPA and S1 reviewed the documents submitted designating S1 as the administrator and went over the requirements of Section 87405 Administrator - Qualifications and Duties. S1 stated they do not have an active administrator’s certificate, but that they only need 4 additional hours to meet the requirements to renew their certificate. LPA and S1 discussed S1’s education and work history. LPA spoke with Staff #2 (S2) Dennis Robeniol and reviewed S2’s active administrator certificate. LPA and S2 discussed S2’s qualifications to be the administrator. S1 reviewed Section 87405 Administrator - Qualifications and Duties and stated they understood the requirements. S1 stated the facility will submit a packet for the new administrator meeting all of the qualifications to LPA by 03/23/23.

Based on the observations made during today’s inspection, no deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted and a copy of this report was discussed with and provided to facility representative.
SUPERVISOR'S NAME: Armando J LuceroTELEPHONE: (714) 703-2840
LICENSING EVALUATOR NAME: Sean HaddadTELEPHONE: (714) 335-7094
LICENSING EVALUATOR SIGNATURE:
DATE: 03/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/16/2023
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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