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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306005798
Report Date: 05/13/2025
Date Signed: 05/13/2025 03:12:25 PM

Substantiated


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
03/03/2025 and conducted by Evaluator Kevin Saborit-Guasch
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20250303100218
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:170CENSUS: 150DATE:
05/13/2025
UNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Peggy Ulland, Executive DirectorTIME COMPLETED:
03:20 PM
ALLEGATION(S):
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9
Staff do not meet a resident's catheter needs while in care
INVESTIGATION FINDINGS:
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On this day, Licensing Program Analyst (LPA) Kevin Saborit-Guasch made an unannounced visit to the facility for the purpose of following up on the investigation of the allegations listed above as well as to deliver findings to the licensee. LPA was greeted and granted entry by facility staff after introducing himself and stating the purpose of the visit to the facility's front desk. Executive Director Peggy Ulland was present and assisted with the visit.

During the initial visit on March 15, 2025, LPA requested and obtained resident records, resident census and employee roster. LPA accompanied by staff conducted a tour of the facility's memory care unit. LPA additionally conducted two staff interviews and one resident interview. Documentation of an in-service training conducted on catheter care and perineal care was also provided by facility staff.
Additional witness interviews conducted via telephone over the course of the investigation.
CONTINUED ON FORM LIC9099-C
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Kevin Saborit-Guasch
LICENSING EVALUATOR SIGNATURE:

DATE: 05/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/13/2025
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 5
Control Number 22-AS-20250303100218
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: 05/13/2025
NARRATIVE
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CONTINUED FROM FORM LIC9099
Regarding the allegation that Staff do not meet a resident's catheter needs while in care, the following has been concluded: Per a review of resident R1's transitional information gathered prior to R1's move-in on October 30, 2024 as well as a review of R1's physician report and pre-admission appraisal, it is indicated that R1 moved into the facility with a foley catheter already in place. The transitional information indicates that the resident's plan of care calls for the foley bag to be emptied once it reaches a third to a half of its full capacity. Based on photographs provided by witnesses dated January 14, 2025, there have been instances during which the foley bag was not emptied timely as foley bag appeared to be almost full at the time of the photograph being taken. Another instance of the catheter bag not being emptied overnight was found upon a review of R1's chart for May 2025. R1 had a documented history of urinary tract infections prior to their admission at the facility, therefore it is unsure whether the catheter management is related to any active infection occurring.

Per statements made by facility staff during the initial investigation visit, an in-service regarding catheter care and perianal care was conducted after the incidents evidenced above.

As a result, the allegation is found to be Substantiated, meaning that based on the evidence gathered during this investigation, the preponderance of evidence standard has been met. A corresponding deficiency is being cited on the attached form LIC9099-D.

An exit interview was conducted with facility staff. A copy of the report along with appeal rights were provided.
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Kevin Saborit-Guasch
LICENSING EVALUATOR SIGNATURE:

DATE: 05/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/13/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 5
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
03/03/2025 and conducted by Evaluator Kevin Saborit-Guasch
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20250303100218

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:170CENSUS: 150DATE:
05/13/2025
UNANNOUNCEDTIME BEGAN:
01:00 PM
MET WITH:Peggy Ulland, Executive DirectorTIME COMPLETED:
03:20 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff do not meet a resident's incontinence need while in care

Staff are not meeting a resident's medical needs while in care
INVESTIGATION FINDINGS:
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5
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13
On this day, Licensing Program Analyst (LPA) Kevin Saborit-Guasch made an unannounced visit to the facility for the purpose of following up on the investigation of the allegations listed above as well as to deliver findings to the licensee. LPA was greeted and granted entry by facility staff after introducing himself and stating the purpose of the visit to the facility's front desk. Executive Director Peggy Ulland was present and assisted with the visit.

During the initial visit on March 15, 2025, LPA requested and obtained resident records, resident census and employee roster. LPA accompanied by staff conducted a tour of the facility's memory care unit. LPA additionally conducted two staff interviews and one resident interview. Documentation of an in-service training conducted on catheter care and perineal care was also provided by facility staff.
Additional witness interviews conducted via telephone over the course of the investigation.
CONTINUED ON FORM LIC9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Kevin Saborit-Guasch
LICENSING EVALUATOR SIGNATURE:

DATE: 05/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/13/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 22-AS-20250303100218
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: 05/13/2025
NARRATIVE
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CONTINUED FROM FORM LIC9099-A
Regarding the allegation that Staff do not meet a resident's incontinence need while in care, the following has been concluded: On February 25, 2025, R1 attended an appointment with their urologist for a scheduled replacement of their catheter bag. Upon arriving at their health care provider's office, the resident was found to be in soiled diapers. Per the caregiver's assessment on the day of the visit, peri care was provided on the morning of the appointment prior to the resident being brought out to the dining hall, where she was then directly picked up by family, it is therefore not possible to establish whether the diaper was soiled due to insufficient intervention from facility staff.

Regarding the allegation that Staff are not meeting a resident's medical needs while in care, the following has been concluded: an interview with R1 along with a review of R1's resident records demonstrated regularly scheduled medical appointments. Incidents such as a fall occurring in December 2024 were also adequately reported to the resident's primary care physician. Additional charting notes and transmission records were provided for a hospitalization event that occurred in April 2025. There is therefore insufficient evidence to show that facility staff is failing to meet the resident's needs.

As a result, both allegations listed above are found to be Unsubstantiated, meaning that while the alleged incidents may have occurred, or the concerns may be valid, there is not a preponderance of evidence to prove that the alleged violations took place.

An exit interview was conducted and a copy of this report was provided to a facility representative.
SUPERVISORS NAME: Sheila Santos
LICENSING EVALUATOR NAME: Kevin Saborit-Guasch
LICENSING EVALUATOR SIGNATURE:

DATE: 05/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/13/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Citations on this Visit Report are Under Appeal!

Control Number 22-AS-20250303100218
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/13/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
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Under Appeal
Type B
05/30/2025
Section Cited
CCR
87468.2(a)(4)
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Per CCR 87468.2(a)(4) on Additional Personal Rights of Residents in Privately Operated Facilities, residents are entitled: "To care, supervision, and services that meet their individual needs". This requirement is not met as evidenced by:
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Adherence to R1's plan of care to be documented. Documentation to be provided to LPA before the plan of corrections due date.
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Based on the reviewed plan of care, the investigation evidenced insufficient catheter care provided to R1 by facility staff. This constitutes a potential risk to the health, safety and personal rights of individuals 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: Sheila Santos
LICENSING EVALUATOR NAME: Kevin Saborit-Guasch
LICENSING EVALUATOR SIGNATURE:

DATE: 05/13/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/13/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 5