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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 405801595
Report Date: 02/12/2025
Date Signed: 02/12/2025 02:55:11 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 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
02/11/2025 and conducted by Evaluator Rachael De Leon
COMPLAINT CONTROL NUMBER: 29-AS-20250211110740
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:
02/12/2025
UNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:I "Enos" Patacsil, AdministratorTIME COMPLETED:
03:10 PM
ALLEGATION(S):
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Medications were accesable to residents in care
INVESTIGATION FINDINGS:
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Licensing Program Analyst's (LPA's) De Leon and Haner-Tomasko conducted a 10-day Complaint visit to the facility above. LPA met with I. Enos Patacsil Administrator and explained the purpose of the visit.

LPA toured kitchen & dining room medication cupboards during the visit the medication cupboards were locked on LPA visit. LPA requested a resident roster and staff roster.

On the allegation: Medications were accesiable to residents in care. LPA conducted interview with staff which revealed the Long Term Care Ombusman (LTCO) visited the facility on 02/11/2025 and found a medication cupboard unlocked while a reisdent in care was in the dining room area and the staff left the area to attend to another resident in care. Based on the evidence this allegation is deemed Substaniated at this time.

Exit interview conducted, deficnecy cited, copy of report and appeal rights printed for Administrator.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kelly Burley
LICENSING EVALUATOR NAME: Rachael De Leon
LICENSING EVALUATOR SIGNATURE:

DATE: 02/12/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/12/2025
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 29-AS-20250211110740
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

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

FACILITY NAME: PARKVIEW VILLAGE II
FACILITY NUMBER: 405801595
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/12/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
02/19/2025
Section Cited
CCR
87465(h)(2)
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(h)...(2)Centrally stored medicines shall be kept in a safe and locked place that is not accessible to persons other than employees responsible for the supervision of the centrally stored medication.
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Administrator agreed to train staff in regulation 87465 and RCFE Medication Guide, provide proof of trianing with staff signatures.
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Based on interview the licensee did not comply with the regulation above medication was unlocked which posess a ptential health, and safety 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: Rachael De Leon
LICENSING EVALUATOR SIGNATURE:

DATE: 02/12/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/12/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2