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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306000059
Report Date: 07/09/2025
Date Signed: 08/14/2025 09:13:05 AM

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
07/07/2025 and conducted by Evaluator Sean Haddad
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20250707091934
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: 107DATE:
07/09/2025
UNANNOUNCEDTIME BEGAN:
07:30 AM
MET WITH:Miles MouradianTIME COMPLETED:
12:25 PM
ALLEGATION(S):
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Facility staff were rough with resident
INVESTIGATION FINDINGS:
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 This is an amended report

This is an amended reportThis 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 were rough with resident revealed the following: During the course of the investigation, LPA inspected the facility, interviewed AD, Resident Care Director (RCD) Annaliza Yem, staff, and residents, and obtained and reviewed copies of the resident roster, staff roster, and Resident #1’s (R1) Physician’s Report dated January 16, 2025, R1’s Medical Records, the facility’s investigation report dated July 8, 2025, staff files, and R1’s Care Notes.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Sean Haddad
LICENSING EVALUATOR SIGNATURE:

DATE: 08/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/14/2025
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-20250707091934
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: 07/09/2025
NARRATIVE
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It was alleged that R1 refused care from a staff, the staff brought another staff and forced care on R1, and R1 fought back and was injured with a skin tear as a result. LPA inspected the facility, conducted health and safety checks on residents, and observed that R1 has three small scabs on their left arm and a very large hand-shaped bruise on their right arm. Per R1’s Physician’s Report dated January 16, 2025, R1 has mild cognitive impairment but R1’s Medical Records indicate that R1 was diagnosed with dementia with behavioral disturbances on July 2, 2025. LPA interviewed R1 who was aware they were injured, but was unable to provide information regarding how the injuries were sustained due to R1’s dementia diagnosis and LPA noted R1 to be confused and easily agitated. LPA interviewed RCD who stated that on June 24, 2025, Staff #1 (S1) noted that R1, who lived in assisted living at the time, was very soiled and tried to provide care to R1, R1 refused, S1 brought Staff #2 (S2) to help, R1 resisted and attacked S1 and S2, and S1 and S2 completed care for R1 but R1 sustained a skin tear during the incident. LPA reviewed the facility’s investigation report dated July 8, 2025, which indicates that R1’s family had noted a recent cognitive decline in R1 prior to the incident and that shortly after the incident on June 24, 2025, R1 was medically reassessed with a diagnosis of dementia and admitted to the memory care unit. AD stated that after the incident, staff were retrained on resident refusals, providing care, and personal rights. LPA reviewed the staff files for S1 and S2 and confirmed they are both background cleared and have up to date training. LPA attempted to interview S1 and S2, but they were not available for interview. However, their statements are incorporated into the facility’s investigation report dated July 8, 2025 and LPA’s observations confirmed R1’s injuries. RCD stated that S1 and S2 did not follow facility protocol when they forced care on R1 and that they should have waited, given R1 time, called the family, called managers, and taken other measures to prevent the incident as it occurred. LPA reviewed R1’s Care Notes which indicate that R1 was observed to be very confused, not making any sense, and being rude and aggressive with staff and other residents since late February 2025, but R1 was allowed to stay in assisted living until the incident on June 24, 2025. Based on the information obtained, S1 and S2 forced care on R1, an assisted living resident who likely should have been in memory care, resulting in skin tears as well as a very large bruise on R1’s arm indicating that R1 was held very firmly during this incident. 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. Immediate civil penalties are being assessed. See LIC421IM. An exit interview was conducted and a copy of this report and appeal rights was discussed with and provided to facility representative. This is an amended report
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Sean Haddad
LICENSING EVALUATOR SIGNATURE:

DATE: 08/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/14/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 22-AS-20250707091934
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: 07/09/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/15/2025
Section Cited
CCR
87468.1(a)(3)
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87468.1 Personal Rights of Residents in All Facilities (a) … (3) To be free from punishment, humiliation, intimidation, abuse… This requirement was not met as evidenced by:
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The licensee stated they have already conducted staff training on resident refusals, providing care, and personal rights and will submit proof to LPA by POC due date.
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Based on observation and interviews, the licensee did not ensure R1 was free from abuse when S1 and S2 forced care on R1 resulting in skin tears and a large bruise, which poses an immediate personal rights risk to persons in care. CIVIL PENALTY ASSESSED.
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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: 08/14/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/14/2025
LIC9099 (FAS) - (06/04)
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