306005798-5-28-2025-22-AS-APAO-DHPNAK-20250616101741

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306005798
Report Date: 05/28/2025
Date Signed: 05/28/2025 09:28:35 AM

Unfounded

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
05/13/2025 and conducted by Evaluator RoseMarie Ruppert

COMPLAINT CONTROL NUMBER: 22-AS-20250513092805

FACILITY NAME:	PARK VIEW ESTATES		FACILITY NUMBER:	306005798
ADMINISTRATOR:	MARIA ARRIAGA		FACILITY TYPE:	740
ADDRESS:	11360 WARNER AVE.		TELEPHONE:	(949) 333-3486
CITY:	FOUNTAIN VALLEY	STATE: CA	ZIP CODE:	92708
CAPACITY:	170	CENSUS: 148	DATE:	05/28/2025
		UNANNOUNCED	TIME BEGAN:	08:15 AM
MET WITH:	Peggy Ulland, Executive Director		TIME COMPLETED:	09:40 AM

ALLEGATION(S):

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Staff did not provide authorized representatives with a 30 day eviction notice

INVESTIGATION FINDINGS:

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LIcensing Program Analyst (LPA) Rose Ruppert made an unannounced visit to deliver findings for a complaint received in our Regional Office. LPA met with Peggy Ullland, Executive Director (ED) and explained the purpose of the visit.

LPA reviewed Resident #2 (R2)s: ID and Emergency Information Form, Admissions Agreement, Physician's Report, Appraisal Needs and Services Plan, Durable Power of Attorney documentation and Eviction notice documentation. LPA also reviewed Unusual Incident Reports submitted for eviction in 2025 by the facility.

LPA interviewed R2 who acknowledged receipt of eviction notice. The eviction notice was served on March 28, 2025 for non-payment of funds and for R2 to vacate on April 28, 2025. Power of Attorney (POA) stated they did not receive mailed eviction notice on May 9, 2025. ED Ulland emailed the POA, on May 9, 2025, and notified LPA Eboni Bentley regarding this.
(Continued on LIC 9099-C)

Unfounded

Estimated Days of Completion:

SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: RoseMarie Ruppert
LICENSING EVALUATOR SIGNATURE:	DATE: 05/28/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/28/2025

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 22-AS-20250513092805

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: 05/28/2025

NARRATIVE

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(Continued from LIC 9099)

The eviction date was moved to June 10, 2025.

Based on LPA's conversation with R2, R2 understood that the notice was for non-payment and that R2 had until June 10, 2025 to pay or to vacate. LPA interviewed four of four witnesses and two of two staff during the complaint investigation who were aware of R2's situation. LPA obtained a witness statement regarding R2's eviction.

This agency has investigated the complaint that: Staff did not provide authorized representatives with a 30 day eviction notice. We have found that the complaint was unfounded, meaning the allegation was false, could not have happened and/or is without a reasonable basis.

An exit interview was conducted with Peggy Ulland, Executive Director, and a copy of this report was provided to the facility.

SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: RoseMarie Ruppert
LICENSING EVALUATOR SIGNATURE:	DATE: 05/28/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/28/2025

LIC9099 (FAS) - (06/04)

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