306000059-1-13-2023-22-AS-AORZ-D9XVA8-20241011161527

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306000059
Report Date: 01/13/2023
Date Signed: 01/13/2023 01:07:53 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
01/06/2023 and conducted by Evaluator Rosie Quiroz

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20230106134015

FACILITY NAME:	PARK REGENCY RETIREMENT CENTER		FACILITY NUMBER:	306000059
ADMINISTRATOR:	ROSALIE SULLIVAN		FACILITY TYPE:	740
ADDRESS:	1750 W. LA HABRA BLVD.		TELEPHONE:	(714) 441-1164
CITY:	LA HABRA	STATE: CA	ZIP CODE:	90631
CAPACITY:	168	CENSUS: 92	DATE:	01/13/2023
		UNANNOUNCED	TIME BEGAN:	08:42 AM
MET WITH:	Annaliza Abap, Memory Care Director, Kristen Collins, Director of Business Development, Jorge Garcia, Maintenance Director and John Bown, Senior Vice President of Operations		TIME COMPLETED:	01:11 PM

ALLEGATION(S):

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-Facility is in disrepair.
-Facility does not provide a safe environment for residents and staff.

INVESTIGATION FINDINGS:

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On today's date, Licensing Program Analyst (LPA) Rosie Quiroz made an unannouced visit to this facility to initiate the investigation for the complaint allegations listed above. LPA Quiroz was greeted, COVID 19 screened and granted entry by front desk staff and explained the reason for the visit. LPA Quiroz met with Kristen Collins, Director of Business Development (DBD) , Annaliza Abap, Memory Care Director (MCD) Jorge Garcia, Maintenance Director (MD) and John Bowen, Senior Vice President of Operations.
Between 9:34am- 10:29am, LPA Quiroz along (MD) Garcia and (MCD) Abap toured the interior and exterior of facility premises. During today's facility inspection, LPA Quiroz observed dark colored stains, bubbling of ceiling, patches , open ceiling areas and tarped areas in facility hallways on first and second floor throughout the facility, diningroom areas, kitchen area and the following rooms: 159, 169, 239, 245, 247, 243, 213, 221, 226 and 255. This was verified with (MCD) Abap and (MD) Garcia throughout today's facility inspection visit. (MD) Garcia indicated "Trying my best with the leaking but this is a roofing problem." John Bowen, Senior Vice President of Operations indicated, "I agree, it's a roofing problem."
CONTINUED...

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Alisa Ortiz	TELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Rosie Quiroz	TELEPHONE: (559) 753-4610
LICENSING EVALUATOR SIGNATURE:	DATE: 01/13/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/13/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 22-AS-20230106134015

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: 01/13/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 01/16/2023 Section Cited CCR 87303(a)	1 2 3 4 5 6 7	(a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors.This requirement is not being met as evidenced by...CONTINUED BELOW	1 2 3 4 5 6 7	Senior Vice President of Operations John Bowen agreed to submit proof of roof repair project plan along with email communication between facility and landlord of building regarding roof repair initial request and plans to repair by COB 1/16/2023.
	8 9 10 11 12 13 14	On 1/13/2023, between 9:34am- 10:29am, LPA Quiroz observed dark colored stains, bubbling of ceiling, patches, open ceiling areas and tarped areas in facility hallways on first and second floor throughout the facility, diningroom areas, kitchen area and the following rooms: CONTINUED...	8 9 10 11 12 13 14	159, 169, 239, 245, 247, 243, 213, 221, 226, 255. This was verified with (MCD) Abap and (MD) Garcia throughout today's facility inspection visit. (MD) Garcia indicated "Trying my best with the leaking but this is a roofing problem." This poses an immediate health and safety risk to residents in care.
	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.

SUPERVISOR'S NAME: Alisa Ortiz	TELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Rosie Quiroz	TELEPHONE: (559) 753-4610
LICENSING EVALUATOR SIGNATURE:	DATE: 01/13/2023

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/13/2023

LIC9099 (FAS) - (06/04)

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Control Number 22-AS-20230106134015

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: 01/13/2023

NARRATIVE

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CONTINUED...

Interviews conducted with ten of ten interviewees revealed that facility has been having an ongoing leaking problem for over one year and that it's not safe for residents and staff.

Based on the evidence gathered through observations conducted on today's visit and interviews conducted with interviewees, the preponderance of evidence standard has been met, therefore, the allegations "Facility is in disrepair" and "Facility does not provide a safe environment for residents and staff " are found to be SUBSTANTIATED. Facility is being cited per California Code of Regulations Title 22, Division 6, Chapter 1 under Maintenance and Operation 87303(a):The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors.

Facility agreed to submit physician reports, Identification forms and Needs and Services Plans for the following residents: Resident 1- Resident 7, by Close of Business day today 1/13/2023.

An exit interview was conducted with Senior Vice President of Operations John Bowen and a copy of this report, LIC 9099D, LIC 811 Confidential Names and Appeal Rights were provided at exit.

SUPERVISOR'S NAME: Alisa Ortiz	TELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Rosie Quiroz	TELEPHONE: (559) 753-4610
LICENSING EVALUATOR SIGNATURE:	DATE: 01/13/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/13/2023

LIC9099 (FAS) - (06/04)

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