306001157-7-8-2026-22-AS-AINZ-DWHVRH-20260731163959

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306001157
Report Date: 07/08/2026
Date Signed: 07/08/2026 12:47:38 PM

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
06/29/2026 and conducted by Evaluator Jessica Cho

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20260629102353

FACILITY NAME:	PARK TERRACE		FACILITY NUMBER:	306001157
ADMINISTRATOR:	KOEHLER, EUGENE (GENO)		FACILITY TYPE:	740
ADDRESS:	21952 BUENA SUERTE		TELEPHONE:	(949) 888-2250
CITY:	RANCHO SANTA MARGARI	STATE: CA	ZIP CODE:	92688
CAPACITY:	230	CENSUS: 172	DATE:	07/08/2026
		UNANNOUNCED	TIME BEGAN:	08:00 AM
MET WITH:	Geno Koehler- Executive Director		TIME COMPLETED:	12:47 PM

ALLEGATION(S):

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Staff threatened resident.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Jessica Cho made an unannounced visit for the purpose of initiating the complaint investigation into the above allegation. LPA met with Executive Director (ED) Geno Koehler and explained the reason for the visit. During the course of the investigation, LPA interviewed one resident and two staff. LPA obtained the following documentation for review: Resident/Staff Rosters, Face Sheet, Physician's Reports, Care Plan, Emergency Medical Treatment, Podiatry Agreement, hospital records, and Home Health Documentation.

The investigation is as follows: Regarding the allegation, Staff threatened resident, it is alleged Staff #1 (S1) threatened to evict Resident #1 (R1) due to not following rules. R1 is independent with the Activities of Daily Living (ADL) and only receives services via outside agency specialists in which R1 is marked at 10 points per care plan dated June 12, 2026. However, there are no charges to the care. R1 is able to self-administer and store own medications also verified per the doctor's order and Physician's Report (LIC602) dated May 16, 2025.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Jessica Cho
LICENSING EVALUATOR SIGNATURE:	DATE: 07/08/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/08/2026

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 4

Control Number 22-AS-20260629102353

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: 07/08/2026

NARRATIVE

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R1 indicated that they are able to independently care for self and does not need staff to assist them. S1 indicated that R1 does not provide status updates after medical appointments, so S1 had a conversation with R1 two weeks ago explaining the responsibilities of a licensed facility and process of an eviction. S1 denied threatening to evict R1.

Therefore, based on the observations made, interviews which were conducted, and the records that were reviewed, although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the following allegations: Staff threatened resident is deemed UNSUBSTANTIATED.

An exit interview was conducted with Executive Director Geno Koehler, and a copy of this report was provided at the end of the visit.

SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Jessica Cho
LICENSING EVALUATOR SIGNATURE:	DATE: 07/08/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/08/2026

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
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
06/29/2026 and conducted by Evaluator Jessica Cho

PUBLIC

COMPLAINT CONTROL NUMBER: 22-AS-20260629102353

FACILITY NAME:	PARK TERRACE		FACILITY NUMBER:	306001157
ADMINISTRATOR:	KOEHLER, EUGENE (GENO)		FACILITY TYPE:	740
ADDRESS:	21952 BUENA SUERTE		TELEPHONE:	(949) 888-2250
CITY:	RANCHO SANTA MARGARI	STATE:CA	ZIP CODE:	92688
CAPACITY:	230	CENSUS: 172	DATE:	07/08/2026
		UNANNOUNCED	TIME BEGAN:	08:00 AM
MET WITH:	Geno Koehler- Executive Director		TIME COMPLETED:	12:47 PM

ALLEGATION(S):

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Resident sustained ulcers due to lack of care and supervision.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Jessica Cho made an unannounced visit for the purpose of initiating the complaint investigation into the above allegation. LPA met with Executive Director (ED) Geno Koehler and explained the reason for the visit. During the course of the investigation, LPA interviewed one resident and two staff. LPA obtained the following documentation for review: Resident/Staff Rosters, Face Sheet, Physician's Reports, Care Plan, Emergency Medical Treatment, Podiatry Agreement, hospital records, and Home Health Documentation.

The investigation is as follows: Regarding the allegation, Resident sustained ulcers due to lack of care and supervision, it is alleged R1 changes their own bandages for their leg ulcers. Per R1's medical report dated June 5, 2026, R1 presents with two venous leg ulcers on the lower right leg and four ulcers on the lower left leg. LPA observed both lower legs and feet are swollen and discolored. LPA observed the ulcers as R1 independently removed the bandages.

Unfounded

Estimated Days of Completion:

SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Jessica Cho
LICENSING EVALUATOR SIGNATURE:	DATE: 07/08/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/08/2026

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-20260629102353

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: 07/08/2026

NARRATIVE

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LPA observed a first aid supply which consisted of bandages, pads, wound cleanser spray, and other supplies in the resident's room. Per medical progress notes dated June 5, 2026, R1 has had multiple off and on ulceration to the legs for the last 12 years. R1 confirmed being able to independently care for their own wound prior to moving into the facility and does not require assistance from facility staff. R1 confirmed seeing a medical provider weekly at an outpatient wound care clinic. Per current care plan, R1 does not receive any care. Two of two staff interviewed did not corroborate with the allegation of lack of care as R1 independently cares for self and chooses not to provide facility updates for their medical appointments.

This agency has investigated the complaint and based on the observations made, interviews which were conducted and the records that were reviewed, the following allegation: Resident sustained ulcers due to lack of care and supervision is deemed UNFOUNDED. We have found that the complaint was unfounded, meaning that the allegation was false, could not have happened and/or is without a reasonable basis. We have therefore dismissed the complaint.

An exit interview was conducted with Executive Director Geno Koehler, and a copy of this report was provided at the end of the visit.

SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Jessica Cho
LICENSING EVALUATOR SIGNATURE:	DATE: 07/08/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/08/2026

LIC9099 (FAS) - (06/04)

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