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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306005798
Report Date: 05/20/2025
Date Signed: 05/20/2025 01:42:27 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
05/16/2025 and conducted by Evaluator RoseMarie Ruppert
COMPLAINT CONTROL NUMBER: 22-AS-20250516105349
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: 138DATE:
05/20/2025
UNANNOUNCEDTIME BEGAN:
08:10 AM
MET WITH:Peggy Ulland, Executive DirectorTIME COMPLETED:
11:30 AM
ALLEGATION(S):
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Resident call system was not operational
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Rose Ruppert made an unannounced visit to investigate a complaint received in the Regional Office. LPA was greeted and granted entry by Concierge and explained the purpose of the visit.

LPA toured Resident #1 (R1's) apartment in Memory Care with the Maintenance Director (MD). Motion detectors sense movement in the bathroom and living areas in the apartment and staff are alerted using the application on mobile devices and tablets. MD also showed LPA a button outside the apartment entry where staff or residents can also press. MD demonstrated how this worked and concierge could be heard on the walkie calling out the apartment number for care staff to check within two minutes. If staff do not acknowledge within five minutes, the concierge calls it out again and will reach to the manager to respond to the call.

(Continued on LIC 9099-C)
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: RoseMarie Ruppert
LICENSING EVALUATOR SIGNATURE:

DATE: 05/20/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/20/2025
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-20250516105349
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: 05/20/2025
NARRATIVE
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(Continued from LIC 9099)

LPA interviewed resident, who was in the dining room, and asked resident to press pendant to make sure it is working properly. Pendant immediately showed R1's apartment number and location on the mobile app and staff immediately came to clear the pendant by deactivating it with a magnetic sensor. LPA asked three of three residents in the dining room if there were issues with pendants and all had working pendants.

LPA obtained copies of R1's: ID and Emergency Information form, Physician's Report, Appraisal/Needs and Services Plan and a copy of the pendant log from February to May 20, 2025. LPA also obtained current resident and staff rosters.

Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation that the resident call system was not operational is Unsubstantiated. An exit interview was conducted with Cauleen Ritchie, Clinical Specialist and Peggy Ulland, ED and a copy of the report was provided to the facility.
SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: RoseMarie Ruppert
LICENSING EVALUATOR SIGNATURE:

DATE: 05/20/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/20/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2