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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306001157
Report Date: 07/29/2025
Date Signed: 07/29/2025 12:49:57 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
07/25/2025 and conducted by Evaluator Ruth Martinez
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20250725150055
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: 179DATE:
07/29/2025
UNANNOUNCEDTIME BEGAN:
07:50 AM
MET WITH:Geno KoehlerTIME COMPLETED:
01:20 PM
ALLEGATION(S):
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-Facility staff is refusing to give medication to resident.;
-Facility staff is not following doctors orders.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Ruth Martinez conducted an unannounced visit to the facility to initiate an investigation into the above identified complaint allegations. LPA arrived at the facility and was greeted by the receptionist and granted entry. LPA spoke with Gene Koehler, Executive Director, and explained the purpose of the visit.

During the course of the investigation, interviews were conducted, a tour of the physical plant of the facility was conducted, a review of resident records was completed and obtained copies of pertinent documents obtained.

It is alleged facility staff is refusing to give medication to a resident, specifically to Seroquel and Ativan. Interview with 3 of 3 staff stated that resident (R1) had a change in medication earlier this month to their

Cotinued on LIC9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Ruth Martinez
LICENSING EVALUATOR SIGNATURE:

DATE: 07/29/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/29/2025
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 2
Control Number 22-AS-20250725150055
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: 07/29/2025
NARRATIVE
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medication of ABHR, and Seroquel, but R1 never received a physician’s order for Ativan. Record review revealed that prescription for ABHR gel went from a PRN medication to a routine medication. Prescription for Seroquel went from bedtime to twice a day. Comfort hospice records show that updated physicians’ orders were received on July 4, 7th and 23, 2025 for ABHR and Seroquel only and there was no Ativan registered to the order. MAR sheets for July for R1 reflect that all medication prescribed to R1 has been administered and no discrepancies were observed in the logs.

It is alleged that facility staff are not allowing doctors orders. Interviews with 2 of 2 staff stated that R1 had been having more episodes of agitation than usual. Staff reached out to hospice to have prescription of agitation to be changed from PRN to routine medication while primary doctor was on vacation. Staff stated that it was the only medication that was requested to be modified. Record review revealed that hospice documentation from Comfort Hospice visiting professional dated July 7, 2025, reflects that they received a request for ABHR to be made to a routine medication. The physicians order received from Comfort Hospice Inc. on July 7, 2025, stated ABHR gel to be applied four times daily routine and was no longer a PRN medication. Physicians’ orders for July 4th and 23rd, 2025 reflect update to medication dosage and MAR sheets for July reflect the changes to medication and given as prescribed.

Based on the information mentioned above, the Department is unable to ascertain if the allegation occurred as reported. Although the allegations 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 Executive Director 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: 07/29/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/29/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2