306000059-6-18-2025-22-AS-LMOA-DK4PBK-20250731111029

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306000059
Report Date: 06/18/2025
Date Signed: 06/18/2025 04:30:46 PM

Unfounded

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
06/05/2025 and conducted by Evaluator Sean Haddad

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20250605155117

FACILITY NAME:	PARK REGENCY RETIREMENT CENTER		FACILITY NUMBER:	306000059
ADMINISTRATOR:	ASHLEY WILLETT		FACILITY TYPE:	740
ADDRESS:	1750 W. LA HABRA BLVD.		TELEPHONE:	(714) 441-1164
CITY:	LA HABRA	STATE: CA	ZIP CODE:	90631
CAPACITY:	168	CENSUS: 105	DATE:	06/18/2025
		UNANNOUNCED	TIME BEGAN:	12:00 PM
MET WITH:	Miles Mouradian		TIME COMPLETED:	04:45 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Facility staff did not obtain proper medical care for resident’s skin condition

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 did not obtain proper medical care for resident’s skin condition revealed the following: During the course of the investigation, LPA inspected the facility, interviewed residents, witnesses, and staff, and obtained and reviewed copies of the resident roster, staff roster, Resident #1’s (R1) Care Notes, and R1’s Medical Records.

CONTINUED

Unfounded

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 4

Control Number 22-AS-20250605155117

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 R1 contracted a skin condition at the facility around April 1, 2025, facility staff ignored R1’s skin condition as dry skin for weeks, and R1 was not assessed or treated for their skin condition until the end of May 2025. LPA inspected the facility, conducted health and safety checks on residents, and observed no health and safety issues. LPA interviewed two staff responsible for R1’s care who denied the allegation, stating that R1’s condition was noted by facility staff immediately, communicated to R1’s medical providers, and assessed and treated by R1’s medical providers. LPA reviewed R1’s Care Notes which indicate that facility staff first noticed a skin condition on R1 around March 28, 2025 and reported it to R1’s medical providers, applied the prescribed creams to R1 as directed, provided regular updates on R1’s skin condition to R1’s medical providers, requested R1’s medical providers to come check on R1’s condition whenever it worsened, and R1’s medical providers came multiple times to check on R1’s skin. This shows that facility staff reported R1’s skin condition to R1’s medical providers as soon as it was noted and obtained proper medical care for this condition. LPA reviewed R1’s Medical Records which indicate that R1’s medical providers assessed R1’s skin condition and diagnosed it as a rash on April 17 and 21, 2025, as folliculitis on May 6, 2025, and persistent dermatitis on May 27, 2025, and that R1 was prescribed medications for all of these medical conditions. Per R1’s Medical Records, R1 was seen by their medical providers or their representatives on April 8, 2025, and approximately every other day moving forward and that hospice bath aides gave R1 a shower approximately twice a week. This shows that R1’s medical providers saw R1 frequently and would have addressed any skin issues that were not otherwise reported by the facility. LPA interviewed R1 and two witnesses and did not obtain information corroborating the allegation. The information obtained did not corroborate the 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: 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 4

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
06/05/2025 and conducted by Evaluator Sean Haddad

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20250605155117

FACILITY NAME:	PARK REGENCY RETIREMENT CENTER		FACILITY NUMBER:	306000059
ADMINISTRATOR:	ASHLEY WILLETT		FACILITY TYPE:	740
ADDRESS:	1750 W. LA HABRA BLVD.		TELEPHONE:	(714) 441-1164
CITY:	LA HABRA	STATE: CA	ZIP CODE:	90631
CAPACITY:	168	CENSUS: 105	DATE:	06/18/2025
		UNANNOUNCED	TIME BEGAN:	12:00 PM
MET WITH:	Miles Mouradian		TIME COMPLETED:	04:45 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Facility staff are not providing hygiene supplies

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 providing hygiene supplies revealed the following: During the course of the investigation, LPA inspected the facility, interviewed residents and staff, and obtained and reviewed copies of the resident roster, staff roster, and Resident #1’s (R1) Medical Records.

CONTINUED

Unsubstantiated

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: 3 of 4

Control Number 22-AS-20250605155117

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 R1 is not being provided toilet paper or shampoo and as a result of having no shampoo R1’s hair has not been washed for up to a month. LPA inspected 10 resident bathrooms and LPA’s observations did not corroborate the allegation, as all bathrooms had toilet paper and shampoo, including R1’s room. LPA interviewed four staff who denied the allegation. While staff stated that the facility does not provide shampoo, they also denied that residents lack shampoo because shampoo is provided by residents’ families or hospice if the resident is on hospice. Two staff interviewed reported that because R1 is on hospice, the hospice provides both shampoo and showers to R1, R1’s hospice shower aide will get more shampoo if needed, and that there is always shampoo in R1’s room. LPA reviewed R1’s Medical Records which indicate that R1 has been receiving showers from hospice approximately twice a week. LPA interviewed R1 and did not obtain information corroborating the allegation. 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: 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: 4 of 4