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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 405801595
Report Date: 09/17/2024
Date Signed: 09/17/2024 10:28:57 AM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/11/2024 and conducted by Evaluator Erika Miller
COMPLAINT CONTROL NUMBER: 29-AS-20240911115801
FACILITY NAME:PARKVIEW VILLAGE IIFACILITY NUMBER:
405801595
ADMINISTRATOR:I.PATACSIL & C. PATACSILFACILITY TYPE:
740
ADDRESS:1577 BADEN AVE.TELEPHONE:
(805) 474-9030
CITY:GROVER BEACHSTATE: CAZIP CODE:
93433
CAPACITY:6CENSUS: 4DATE:
09/17/2024
UNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Inocencio Patacsil, AdministratorTIME COMPLETED:
10:45 AM
ALLEGATION(S):
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Facility staff did not ensure centrally stored medicines were kept locked and inaccessible to residents in care.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Erika Miller conducted an unannounced initial complaint visit to the facility above on 9/17/24 and met with Administrator, Inocencio Patacsil, and explained the purpose of the visit. LPA interviewed staff and residents and toured the facility.

On 9/9/24 a Witness observed medication in refrigerator was not locked. On 9/10/24, Witness observed that refrigerated medication remained unlocked, and the daily medication storage area located in the dining room area was also unlocked.

On 9/17/24 LPA observed that all medications were locked in cupboard and inaccessible to residents in care. LPA also observed that medication stored in refrigerator was locked in a storage container in refrigerator.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Erika Miller
LICENSING EVALUATOR SIGNATURE:

DATE: 09/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/17/2024
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 29-AS-20240911115801
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: PARKVIEW VILLAGE II
FACILITY NUMBER: 405801595
VISIT DATE: 09/17/2024
NARRATIVE
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Administrator acknowledged that medications in cupboard and refrigerator were left unlocked on 9/9/24 and 9/10/24. Administrator stated that he reminded all staff to lock all medications on 9/10/24. Staff 1 acknowledged that they have been reminded that all medications must be locked and inaccessible to residents in care.

Based on LPAs observations and interviews which were conducted the preponderance of evidence standard has been met, therefore the above allegation(s) is found to be SUBSTANTIATED. California Code of Regulations are being cited on the attached LIC 9099-D.

Exit interview conducted. Report and appeal rights were printed for Administrator.
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Erika Miller
LICENSING EVALUATOR SIGNATURE:

DATE: 09/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/17/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 29-AS-20240911115801
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: PARKVIEW VILLAGE II
FACILITY NUMBER: 405801595
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/17/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/18/2024
Section Cited
CCR
87465(2)
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87465 (2)Incidental Medical and Dental Care. Centrally stored medicines shall be kept in a safe and locked place that is not accessible to persons... This requirement is not met as evidence by:

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Administrator agreed to remind staff to keep medications locked and inaccessible to residents in care by 9/18/24.

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Based on interview, the licensee did not comply with the section cited above when medications were left unlocked and accessible, which posed a potential personal rights risk to residents 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: Kelly Burley
LICENSING EVALUATOR NAME: Erika Miller
LICENSING EVALUATOR SIGNATURE:

DATE: 09/17/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/17/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 3