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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 015601283
Report Date: 05/07/2025
Date Signed: 05/07/2025 05:10:55 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/03/2024 and conducted by Evaluator Grace Luk
PUBLIC
COMPLAINT CONTROL NUMBER: 15-AS-20240903214101
FACILITY NAME:PARKVIEW, THEFACILITY NUMBER:
015601283
ADMINISTRATOR:TIBON, AIREENFACILITY TYPE:
740
ADDRESS:100 VALLEY AVETELEPHONE:
(925) 461-3042
CITY:PLEASANTONSTATE: CAZIP CODE:
94566
CAPACITY:123CENSUS: 100DATE:
05/07/2025
UNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Aireen Tibon, Executive Director
Sherallyn Dones, Resident Care Coordinator		TIME COMPLETED:
04:00 PM
ALLEGATION(S):
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Staff left medication unattended and accessible to residents in care
Staff did not ensure that resident took medication as prescribed
Staff hid or camouflaged resident medication in another substance
Staff do not respond to resident's call for assistance in a timely manner
INVESTIGATION FINDINGS:
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On 5/7/2025 at 10:45AM, Licensing Program Analyst (LPA) G. Luk arrived unannounced to conduct a complaint investigation and deliver findings in regards to the allegations above. LPA met with Executive Director (ED), Aireen Tibon and explained the purpose of the visit. ED was not able to stay to sign the reports and authorized Resident Care Coordinator, Sherallyn Dones to sign CCLD reports.

During the course of investigation, LPA interviewed 3 residents, 6 staff, and witness. LPA also obtained and reviewed emergency information, physician's report, care plan, hospice information, staff roster with contact information, medication list, MAR, doctor's order, incident report, progress notes, and pull cord log.

Staff left medication unattended and accessible to residents in care
Interview with residents revealed they have not witness unlocked medications at the facility. Interview with staff indicated that medication carts are locked when staff are not present to monitor the medication cart.
(Continue on LIC9099C...)
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Grace Luk
LICENSING EVALUATOR SIGNATURE:

DATE: 05/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/07/2025
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 15-AS-20240903214101
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612
FACILITY NAME: PARKVIEW, THE
FACILITY NUMBER: 015601283
VISIT DATE: 05/07/2025
NARRATIVE
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Staff did not ensure that resident took medication as prescribed
Interview with residents revealed staff are good at giving medication. Interview with staff indicated staff would compare the resident's medication with E-MAR prior to administering medications to residents.

Staff hid or camouflaged resident medication in another substance
Interview with staff revealed that only residents that has a crushed order would have their medications crushed and mixed with applesauce. R1 had a doctor's order for crushed medications and mixed with applesauce.

Staff do not respond to resident's call for assistance in a timely manner
Interview with residents revealed that staff would take a few minutes to respond to call button. Interview with staff indicated there was an issue with staff clearing the call after responding to residents which caused a longer time in the pull cord logs.

Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did occur, therefore the allegations are UNSUBSTANTIATED.

Exit interview conducted with Sherallyn Dones. A copy of this report provided.
SUPERVISORS NAME: Harpreet Humpal
LICENSING EVALUATOR NAME: Grace Luk
LICENSING EVALUATOR SIGNATURE:

DATE: 05/07/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/07/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 2