<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306005798
Report Date: 11/01/2024
Date Signed: 11/01/2024 01:36:44 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
09/13/2022 and conducted by Evaluator RoseMarie Ruppert
COMPLAINT CONTROL NUMBER: 22-AS-20220913154817
FACILITY NAME:PARK VIEW ESTATESFACILITY NUMBER:
306005798
ADMINISTRATOR:HEATHER MYERSFACILITY TYPE:
740
ADDRESS:11360 WARNER AVE.TELEPHONE:
(949) 333-3486
CITY:FOUNTAIN VALLEYSTATE: CAZIP CODE:
92708
CAPACITY:150CENSUS: 121DATE:
11/01/2024
UNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Peggy Ulland, AdministratorTIME COMPLETED:
02:00 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Facility staff not trained to conduct proper response to emergency disaster.
Facility failed to provide adequate staffing to meet resident's needs.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Rose Ruppert made an unannounced complaint visit to deliver amended findings for the above allegations from September 13, 2022. LPA was greeted and granted entry into the facility by the concierge and met with Peggy Ulland, Executive Director and stated the purpose of the visit.

During the investigation LPAs Rosie Quiroz and Rose Ruppert interviewed staff, residents and any witnesses regarding the events from 2022 and requested the staffing schedule, resident roster, staff disaster training records and fire drill reports as well as a copy of the Emergency Disaster Manual.
Based on seven of seven staff interviews, all staff stated they are trained on how to properly respond to an emergency drill. LPA obtained and reviewed records by Fire Drill Service; the contracted company who conducted fire and disaster drill trainings from 2022-2024. Drills were conducted on almost a monthly basis. Staff stated memory care residents are not evacuated during these drills due to the manpower and amount of time it takes to evacuate the entire unit during drills. The facility has since worked with the
(Continued on LIC 9099-C)

Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: RoseMarie Ruppert
LICENSING EVALUATOR SIGNATURE:

DATE: 11/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/01/2024
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-20220913154817
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 VIEW ESTATES
FACILITY NUMBER: 306005798
VISIT DATE: 11/01/2024
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
(Continued from LIC 9099)

Fountain Valley Fire Marshall to ensure the facility is able to demonstrate proper evacuation and disaster preparedness.

Seven of seven staff interviews also stated that there are no staffing issues at the present time. At the time of the allegation in 2022, the corporate office stated that facilities experienced staffing shortages, due to the pandemic. LPA Quiroz obtained and reviewed facility staffing schedules to ensure there were staff scheduled to work. LPA Quiroz observed on September 21, 2022 that there were four staff members in Memory Care, five staff members for Assisted Living, two Medical Technicians (Med Techs), an Activity Director and a Resident Coordinator. LPA Quiroz observed three caregivers with fifteen Memory Care residents in the Activity Room participating in karaoke during the facility tour and residents were engaged in the activity.

Although the above allegations may have happened there is not a preponderance of evidence to prove the alleged violations occurred; therefore, the allegations that: facility staff are not trained to conduct the proper response to an emergency disaster and that the facility failed to provide adequate staffing to meet resident’s needs are unsubstantiated.

An exit interview was conducted with Peggy Ulland, Executive Director (ED) and a copy of this report was provided to the facility.

SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: RoseMarie Ruppert
LICENSING EVALUATOR SIGNATURE:

DATE: 11/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/01/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2