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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 015601283
Report Date: 04/17/2025
Date Signed: 04/18/2025 01:43:07 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, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/14/2025 and conducted by Evaluator Grace Luk
PUBLIC
COMPLAINT CONTROL NUMBER: 15-AS-20250414103432
FACILITY NAME:PARKVIEW, THEFACILITY NUMBER:
015601283
ADMINISTRATOR:TIBON, AIREENFACILITY TYPE:
740
ADDRESS:100 VALLEY AVETELEPHONE:
(925) 461-3042
CITY:PLEASANTONSTATE: CAZIP CODE:
94566
CAPACITY:123CENSUS: 101DATE:
04/17/2025
UNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Aireen Tibon, Executive DirectorTIME COMPLETED:
04:00 PM
ALLEGATION(S):
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Staff did not follow general food safety requirements
Facility refrigerator temperature is not maintained a maximum of 40 degrees F
Facility staff did not have proper training for the operation of the food service
INVESTIGATION FINDINGS:
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On 4/17/2025 at 10:30AM, Licensing Program Analyst (LPA) G. Luk arrived unannounced to conduct a complaint investigation and deliver findings in regards to the allegations above. LPA met with Executive Director, Aireen Tibon and explained the purpose of the visit.

During the course of investigation, LPA interviewed 5 staff and complainant. LPA reviewed and obtained refrigerators/freezer temperature logs, facility menu, and staff training documents.

Staff did not follow general food safety requirements
LPA observed the sandwich knife was wiped using a towel that was on the counter. Interview with S3 revealed that sandwich knife was wiped with towel dipped in sanitizer instead of cleaned after each use. (Continue on LIC9099C...)
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Grace Luk
LICENSING EVALUATOR SIGNATURE:

DATE: 04/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/17/2025
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 4
Control Number 15-AS-20250414103432
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME: PARKVIEW, THE
FACILITY NUMBER: 015601283
VISIT DATE: 04/17/2025
NARRATIVE
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Facility refrigerator temperature is not maintained a maximum of 40 degrees F. LPA observed walk-in refrigerator temperature was at 48 degrees F seen on internal thermometer and the sandwich refrigerator temperature was at 50 degrees F seen on internal thermometer.

Facility staff did not have proper training for the operation of the food service
LPA observed S6 had ServSafe certification which expired on 9/24/2024.

Based on LPA's information obtained during investigation, the preponderance of evidence standard has been met; therefore, the above allegations are found to be SUBSTANTIATED. California Code of Regulations, Title 22, are being cited on the attached LIC9099D.

Exit interview conducted. A copy of this report and appeal rights provided.
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Grace Luk
LICENSING EVALUATOR SIGNATURE:

DATE: 04/17/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/17/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 15-AS-20250414103432
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612

FACILITY NAME: PARKVIEW, THE
FACILITY NUMBER: 015601283
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/17/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/09/2025
Section Cited
CCR
87555(b)(30)
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General Food Service Requirements. All utensils used for eating and drinking and in preparation of food and drink, shall be cleaned and sanitized after each usage. This requirement is not met as evidence by:
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Executive Director (ED) has agreed to conduct training for all kitchen staff regarding food safety and proper cleaning of utensils.
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Based on observation and interview, licensee did not comply with the section cited above by not cleaning the utensils after each use which poses a potential health and safety risk to the persons in care.
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ED will submit staff sign in sheet with training materials to CCLD by POC date.
Type B
05/09/2025
Section Cited
CCR
87555(b)(21)
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General Food Service Requirements. ...refrigerators of adequate size shall maintain a maximum temperature of 40 degrees F (4 degrees C)... This requirement is not met as evidence by:
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ED has agreed to lower the walk-in and sandwich refrigerator temperature to less than 40 degrees and submit picture proof to CCLD by POC date.
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Based on observation, licensee did not comply with the section cited above by having the walk-in and sandwich refrigerator temperature above 40 degrees F which poses a potential health and safety risk to the persons in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Grace Luk
LICENSING EVALUATOR SIGNATURE:

DATE: 04/17/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/17/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 15-AS-20250414103432
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612

FACILITY NAME: PARKVIEW, THE
FACILITY NUMBER: 015601283
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/17/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/09/2025
Section Cited
CCR
87555(b)(17)
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General Food Service Requirements. In facilities licensed for fifty (50) or more...a full-time employee qualified by formal training ...shall be responsible for the operation of the food service... This requirement is not met as evidence by:
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Executive Director (ED) has agreed to create a plan for S6 to obtain current training due to S6 is on leave of absence and submit plan to CCLD by POC date.
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Based on record review, licensee did not comply with the section cited above by not having current training which poses a potential health and safety risk to the persons in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Grace Luk
LICENSING EVALUATOR SIGNATURE:

DATE: 04/17/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/17/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 4