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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306005798
Report Date: 03/12/2026
Date Signed: 03/12/2026 12:57:01 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
03/04/2026 and conducted by Evaluator Eboni Bentley
COMPLAINT CONTROL NUMBER: 22-AS-20260304153800
FACILITY NAME:PARK VIEW ESTATESFACILITY NUMBER:
306005798
ADMINISTRATOR:MARIA ARRIAGAFACILITY TYPE:
740
ADDRESS:11360 WARNER AVE.TELEPHONE:
(657) 384-1001
CITY:FOUNTAIN VALLEYSTATE: CAZIP CODE:
92708
CAPACITY:170CENSUS: 155DATE:
03/12/2026
UNANNOUNCEDTIME BEGAN:
08:00 AM
MET WITH:Peggy Ulland - Executive DirectorTIME COMPLETED:
01:00 PM
ALLEGATION(S):
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Facility is in disrepair.
INVESTIGATION FINDINGS:
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On March 12, 2026, Licensing Program Analyst (LPA) Eboni Bentley arrived at the facility unannounced for the purpose of conducting the 10-day complaint investigation into the above allegation. LPA was greeted and granted entry by Maintenance Director Matt Yem, after explaining the purpose of the visit. Executive Director (ED) Peggy Ulland arrived shortly to assist with the investigation.

During the visit, LPA conducted a tour of the facility kitchen with staff and observed the refridgerator, freezer, dry storage room, cooking area, and dishwashing area. LPA reviewed facility documents including: Resident Roster, Staff Roster, Staff Contacts, Staff Schedules, Direct Supply Tels work order, and Ecolab Service Request/Inspection report. Interviews were conducted with staff and witnesses.


CONTINUE TO LICE9099-C....
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Eboni Bentley
LICENSING EVALUATOR SIGNATURE:

DATE: 03/12/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/12/2026
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-20260304153800
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: 03/12/2026
NARRATIVE
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The following was determined during the investigation:

Regarding the allegation, Facility is in disrepair, it was reported that there was a dishwasher leaking in the kitchen, resulting in excessive puddles of water on the kitchen floor. During the visit, LPA observed a dishwasher in working order. Four out of five staff interviewed confirmed the allegation, stating the dishwasher was not working for at least one week prior to being repaired. One staff stated the leak began on February 25, 2026 and repairs were requested on multiple occasions. A record review confirmed the machine was leaking and repairs had not been completed until March 4, 2026, per Ecolab Service Request/Inspection Report dated March 4, 2026 at 3:18pm. The facility also provided the Direct Supply Tels work order dated March 2, 2026 and two out of four five staff stated the initial request for repair was made to Industrial Electric on that date. The facility decided not to go with the vendor and requested service from Ecolab on March 3, 2026. The investigation revealed the facility failed to repair the dishwasher in a timely manner, causing staff to wash dishes by hand and use a squeegee to remove excess water on the dishwashing area floor for several days.

During the tour of the kitchen, LPA also observed a freezer, reported to be in disrepair. The freezer was taped off and labeled "Do Not Touch or move (Electrical Wire Exposed)." Five out of five staff confirmed the freezer was not working at the time of the visit and was not working since March 11, 2026. One staff stated the freezer was scheduled for service later that day.

Therefore, based on LPA's observations, interviews which were conducted, and the records that were reviewed, the preponderance of evidence standard has been met, therefore the following allegation: Facility is in disrepair is deemed SUBSTANTIATED as per Title 22, Division 6, Chapter 8 of the California Code of Regulations. A deficiency is being cited on the attached LIC 9099D.

An exit interview was conducted with Executive Director Peggy Ulland, and a copy of this report, LIC9099D, and the appeal rights were provided at exit.
SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Eboni Bentley
LICENSING EVALUATOR SIGNATURE:

DATE: 03/12/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/12/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 22-AS-20260304153800
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: 03/12/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/19/2026
Section Cited
CCR
87303(a)
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87303(a)The facility shall be clean, safe sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors.
This requirement is not met as evidenced by:
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The administer stated the freezer will be repaired and will provide proof to CCLD by POC due date.
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Based on observation, interviews, and record review, the facility failed to comply with the section cited above in two out of two kitchen appliances, which poses a potential risk to persons in care. Interviews and record review revaled the dishwasher was leaking for at least one week and LPA observed a freezer in disrepair during the visit.
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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: Lourdes Montoya
LICENSING EVALUATOR NAME: Eboni Bentley
LICENSING EVALUATOR SIGNATURE:

DATE: 03/12/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/12/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 3