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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 01:37:03 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
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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Facility staff does not respond to the call system in a timely manner
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) to check that R1s pendant call system was working. LPA observed pendant and motion sensors to be operational. 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 how long it took staff to respond to calls for assistance. Three of three residents stated most response times are within fifteen to forty-five minutes. R1 stated it has taken as long as two hours to get staff to respond to a (Continued on LIC 9099-C)

Substantiated
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 3
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)
pendant call.

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.

LPA reviewed the pendant log and found several dates and times where the response time was longer than two hours. Staff interviews stated caregivers know to clear pendants and will continue to work on this with staff. Family have been working with the facility regarding this matter and pendant logs show there has been improvement in the recent month and that most pendant calls are answered within a twenty minute period.

Based on LPA observations, record review and interviews conducted, the preponderance of evidence standard has been met, therefore the allegation that: Facility staff does not respond to the call system in a timely manner, is found to be Substantiated. A deficiency has been cited per California Code of Regulations. An exit interview was conducted with Cauleen Ritchie, Clinical Specialist and a copy of this report, LIC 858, LIC 9099-D and Appeal Rights were 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 3
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/20/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Deficiency Dismissed
Type A
05/21/2025
Section Cited
CCR
87464(f)(1)
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878464 Basic Services: (f) Basic services shall at a minimum include: (1) Care and supervision as defined in Section 87101(c)(3) and Health and Safety Code section 1569.2(c). This requirement is not met as evidenced by: Based on LPA record review
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Facility will conduct an in-service training with staff regarding call pendant procedures. Executive Director (ED) Ulland will send proof of documentation to LPA by POC date via email with training provided and procedures implemented to address this issue.
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and interviews with residents and staff, pendant call times were not responded to in a timely manner. This poses and immediate health and safety risk to persons 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: Alisa Ortiz
LICENSING EVALUATOR NAME: RoseMarie Ruppert
LICENSING EVALUATOR SIGNATURE:

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

DATE: 05/20/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 3