Community Care Licensing

Document Has Been Signed on 04/25/2024 06:09 PM - It Cannot Be Edited

FACILITY NAME:	PARKVIEW, THE		FACILITY NUMBER:	015601283
ADMINISTRATOR/ DIRECTOR:	TIBON, AIREEN		FACILITY TYPE:	740
ADDRESS:	100 VALLEY AVE		TELEPHONE:	(925) 461-3042
CITY:	PLEASANTON	STATE: CA	ZIP CODE:	94566
CAPACITY: 123		CENSUS: 96	DATE:	04/25/2024
TYPE OF VISIT:	Case Management - Annual Continuation	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	09:45 AM
MET WITH:	Aireen Tibon, Executive Director		TIME VISIT/ INSPECTION COMPLETED:	03:30 PM

SUPERVISORS NAME: Harpreet Humpal LICENSING EVALUATOR NAME: Grace Luk LICENSING EVALUATOR SIGNATURE: DATE: 04/25/2024

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

FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/25/2024

Link to Parent Document Below:

FACILITY NAME: PARKVIEW, THE	FACILITY NUMBER: 015601283
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 04/25/2024

Type B

Section Cited

CCR

87411(f)

(f) All personnel, including the licensee and administrator, shall be in good health, and physically and mentally capable of performing assigned tasks. Good physical health shall be verified by a health screening, including a chest x-ray or an intradermal test, performed by a physician not more than six (6) months prior to or seven (7) days after employment or licensure. A report shall be made of each screening, signed by the examining physician. The report shall indicate whether the person is physically qualified to perform the duties to be assigned, and whether he/she has any health condition that would create a hazard to him/herself, other staff members or residents. A signed statement shall be obtained from each volunteer affirming that he/she is in good health.Personnel with evidence of physical illness or emotional instability that poses a significant threat to the well-being of residents shall be relieved of their duties. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above by not having TB test completed for staff which poses a potential health and safety risk to persons in care.
	POC Due Date: 05/24/2024
	Plan of Correction
1 2 3 4	Executive Director has agreed to obtain TB test for S3 and submit a copy to CCLD by POC date.

SUPERVISOR'S NAME: Harpreet Humpal LICENSING EVALUATOR NAME: Grace Luk LICENSING EVALUATOR SIGNATURE: DATE: 04/25/2024

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

FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/25/2024

Link to Parent Document Below:

FACILITY NAME: PARKVIEW, THE	FACILITY NUMBER: 015601283
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 04/25/2024

Type B

Section Cited

CCR

87705(c)(5)

(c) Licensees who accept and retain residents with dementia shall be responsible for ensuring the following: (5) Each resident with dementia shall have an annual medical assessment as specified in Section 87458, Medical Assessment, and a reappraisal done at least annually, both of which shall include a reassessment of the resident’s dementia care needs. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above by not having current medical assessment for residents which poses a potential health and safety risk to persons in care.
	POC Due Date: 05/24/2024
	Plan of Correction
1 2 3 4	Executive Director has agreed to obtain current medical assessments for R2 and R4 and will submit a copy to CCLD by POC date.

Type B

Section Cited

CCR

87411(c)(1)

(c) All RCFE staff who assist residents with personal activities of daily living shall receive initial and annual training as specified in Health and Safety Code sections 1569.625 and 1569.69 (1) Staff providing care shall receive appropriate training in first aid from persons qualified by such agencies as the American Red Cross. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above by not having current first aid training for staff which poses a potential health and safety risk to persons in care.
	POC Due Date: 05/24/2024
	Plan of Correction
1 2 3 4	Executive Director has agreed to obtain current first aid for S5 and will submit a copy to CCLD by POC date.

SUPERVISOR'S NAME: Harpreet Humpal LICENSING EVALUATOR NAME: Grace Luk LICENSING EVALUATOR SIGNATURE: DATE: 04/25/2024

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

FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/25/2024