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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306005798
Report Date: 04/11/2025
Date Signed: 04/14/2025 07:49:09 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
04/03/2025 and conducted by Evaluator Andrea Mendivil
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20250403142929
FACILITY NAME:PARK VIEW ESTATESFACILITY NUMBER:
306005798
ADMINISTRATOR:MARIA ARRIAGAFACILITY TYPE:
740
ADDRESS:11360 WARNER AVE.TELEPHONE:
(949) 333-3486
CITY:FOUNTAIN VALLEYSTATE: CAZIP CODE:
92708
CAPACITY:150CENSUS: 145DATE:
04/11/2025
UNANNOUNCEDTIME BEGAN:
07:56 AM
MET WITH:Peggy Ulland- Executive Director TIME COMPLETED:
03:45 PM
ALLEGATION(S):
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Staff did not ensure that residents took their medication as prescribed
INVESTIGATION FINDINGS:
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On this day, Licensing Program Analyst (LPA) Andrea Mendivil made an unannounced visit to conduct a complaint investigation. LPA was greeted and granted entry into the facility and explained the reason for the visit.

The Department received a complaint on 04/03/2025 and the initial 10 day visit was conducted on 4/11/2025. LPA Mendivil interviewed staff and residents as well as obtained copies of medication administration records (MAR) staff schedules and resident physicians report. Regarding the allegation that staff did not ensure that residents took their medication as prescribed, the investigation revealed the following:

Interviews with 3 out of 4 residents stated they received their medications as prescribed, the 4th resident manages their own medications. 3 out of 4 residents stated staff finds them when it is time for their medications if they are not in their rooms. 4 out of 4 staff stated they ensure all residents are taking their medications as prescribed.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Andrea Mendivil
LICENSING EVALUATOR SIGNATURE:

DATE: 04/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/11/2025
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-20250403142929
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: PARK VIEW ESTATES
FACILITY NUMBER: 306005798
VISIT DATE: 04/11/2025
NARRATIVE
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4 out of 4 staff stated they wait until the resident is done taking their medications to leave. All staff interviewed stated if a resident refuses a medication they will notate that in the MAR. 4 out of 4 staff stated none of the residents pocket or hide medications.

Therefore based on the preponderance of evidence through records reviewed and interviews the allegation Staff did not ensure that residents took their medication as prescribed is determined to be UNSUBSTANTIATED, meaning although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur.

An exit interview was conducted and a copy of this report was provided.
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Andrea Mendivil
LICENSING EVALUATOR SIGNATURE:

DATE: 04/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/11/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2