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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306001157
Report Date: 03/10/2026
Date Signed: 03/10/2026 09:38:26 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 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
12/03/2025 and conducted by Evaluator Ruth Martinez
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20251203102018
FACILITY NAME:PARK TERRACEFACILITY NUMBER:
306001157
ADMINISTRATOR:KOEHLER, EUGENE (GENO)FACILITY TYPE:
740
ADDRESS:21952 BUENA SUERTETELEPHONE:
(949) 888-2250
CITY:RANCHO SANTA MARGARISTATE: CAZIP CODE:
92688
CAPACITY:230CENSUS: DATE:
03/10/2026
UNANNOUNCEDTIME BEGAN:
07:45 AM
MET WITH:Joni Payabyab, Resident care ManagerTIME COMPLETED:
10:00 AM
ALLEGATION(S):
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Staff do not answer residents calls for assistance timely.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Ruth Martinez conducted an unannounced visit to the facility to conclude investigation into the above identified complaint allegations.

Findings are based upon this investigation which included tour of the facility, facility file review, resident file review, interviews conducted, and copies of pertinent records.

It is alleged that staff do not answer residents’ calls for assistance timely, specifically to for resident (R1) and resident (R2) for dates if September 10, 2025, and October 23, 2025. LPA Martinez conducted a tour of the physical plant of the facility on December 11, 2025, and tested various pull cord throughout the facility. The response time from care staff was 2 minutes at all pull cord testing. Interview with staff stated that with

Continued on LIC809-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Ruth Martinez
LICENSING EVALUATOR SIGNATURE:

DATE: 03/10/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/10/2026
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 2
Control Number 22-AS-20251203102018
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: PARK TERRACE
FACILITY NUMBER: 306001157
VISIT DATE: 03/10/2026
NARRATIVE
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the two dates in question for September 10, 2025, and R1 the pull cord was pulled on and off several times and when staff went to check on resident staff was informed the cord was pulled and then turned off by person pulling the alarm. Since the alert showed multiple times, staff went in to check on residents regardless of if the alarm was cleared. For October 23, 2025, the staff received an alert and R2 waited minutes and when staff arrived at the apartment 911 had already been called by a family member. Review of records device activity report for R1 & R2 apartment reflect that on September 10, 2025, the cord was pulled four times as follows: 4:14.58 AM pulled cleared 4:15:20Am duration of 22 seconds and 4:31:22 AM pulled cleared 4:31:36 AM. October 23, 2025, the cord was pulled at 7:08:06PM cleared 7:19:19PM duration of 11 minutes and 13 seconds. Interview with 5 of 5 residents stated that when they press their pendent or pull the cord the staff always respond within a reasonable time, and they don’t wait to long for assistance.

Based on the information mentioned above, the Department is unable to ascertain if the 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 with the facility representative and a copy of this LIC9099 report was left at facility.
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Ruth Martinez
LICENSING EVALUATOR SIGNATURE:

DATE: 03/10/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/10/2026
LIC9099 (FAS) - (06/04)
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