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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306005798
Report Date: 11/18/2024
Date Signed: 11/18/2024 02:32:56 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
12/07/2022 and conducted by Evaluator RoseMarie Ruppert
COMPLAINT CONTROL NUMBER: 22-AS-20221207111938
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: 123DATE:
11/18/2024
UNANNOUNCEDTIME BEGAN:
02:15 PM
MET WITH:Peggy Ulland, Executive DirectorTIME COMPLETED:
02:29 PM
ALLEGATION(S):
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Staff failed to provide supervision resulting in not meeting residents needs
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPAs) Rose Ruppert and Fred Arias made an unannounced complaint visit to deliver amended findings for the above allegation from December 7, 2022. LPAs were greeted and granted entry into the facility by the concierge and met with Peggy Ulland, Executive Director (ED) and stated the purpose of the visit.

It was reported Staff 1 (S1) was not providing proper supervision to residents in care resulting in resident’s needs not being met. During the investigation LPAs Rosie Quiroz and Alvaro Ramirez interviewed six of six staff members and one witness regarding the events from 2022. Five of the six staff members denied the allegation that there was inadequate staff supervision in Memory Care and the witness only observed staffing issues on the PM shift in 2022. Six of six staff members and witness interviewed all did not report observing issues related to S1’s performance. In August 2024 LPA Ruppert interviewed five of five staff regarding current staffing and five of five stated there are no staffing issues at this time. One of five staff
(Continued on LIC 9099)
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: RoseMarie Ruppert
LICENSING EVALUATOR SIGNATURE:

DATE: 11/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/18/2024
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-20221207111938
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: 11/18/2024
NARRATIVE
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(Continued from LIC 9099)
members interviewed reported they did not have any issues with S1 and that S1 was a leader and always helped the team.

LPA Quiroz interviewed S1 who acknowledged the facility lacked staffing at times and that some residents can be more difficult to assist than others. S1 denied having any knowledge of abuse happening within the facility and was aware of requirements to report if observed. LPA Ruppert requested and reviewed the employee file mentioned in the complaint and there were no disciplinary actions for this employee. S1 resigned from the facility in 2023 due to obtaining another job.

LPA Ruppert requested staffing schedules from November and December 2022. Facility was unable to provide documentation since home office changed staffing software applications. A technical violation was given since records missing did not pose an immediate or potential health risk to persons in care. Since ED Ulland’s arrival the facility has implemented uploading monthly and daily staff schedules into SharePoint to archive documents.

Although the above allegation may have happened there is not a preponderance of evidence to prove the alleged violation occurred; therefore, the allegation that staff failed to provide supervision resulting in not meeting residents’ needs is unsubstantiated.

An exit interview was conducted with Peggy Ulland, Executive Director (ED) and a copy of this report and LIC 9102-TV was provided to the facility.

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

DATE: 11/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/18/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2