015601283-2-7-2025-15-AS-YFLS-DEMVXM-20250310164946

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 015601283
Report Date: 02/07/2025
Date Signed: 02/07/2025 02:00:40 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND ASC, 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
07/15/2024 and conducted by Evaluator Alona Gomez

COMPLAINT CONTROL NUMBER: 15-AS-20240715101039

FACILITY NAME:	PARKVIEW, THE		FACILITY NUMBER:	015601283
ADMINISTRATOR:	TIBON, AIREEN		FACILITY TYPE:	740
ADDRESS:	100 VALLEY AVE		TELEPHONE:	(925) 461-3042
CITY:	PLEASANTON	STATE: CA	ZIP CODE:	94566
CAPACITY:	123	CENSUS: 101	DATE:	02/07/2025
		UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:	Executive Director, Aireen Tibon		TIME COMPLETED:	02:10 PM

ALLEGATION(S):

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Facility is refusing to take resident back into care

INVESTIGATION FINDINGS:

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On 2/07/2025 at 1:00 PM, Licensing Program Analyst (LPA) A. Gomez arrived unannounced to deliver findings for the above allegations. LPA met with Executive Director, Aireen Tibon and explained the purpose of the visit.

During course of the investigation, LPA conducted interviews with facility staff, and witnesses. Documents including but not limited to R1’s admission agreement, physician’s report, care plans, incident reports, and email correspondences were reviewed. LPA visited the facility on 7/30/2024 and 12/20/2024.

Report Continues on LIC9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Yvonne Flores-Larios	TELEPHONE: (510) -28-0517
LICENSING EVALUATOR NAME: Alona Gomez	TELEPHONE: 510-239-1306
LICENSING EVALUATOR SIGNATURE:	DATE: 02/07/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/07/2025

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 15-AS-20240715101039

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
OAKLAND ASC, 1515 CLAY STREET, STE. 310
OAKLAND, CA 94612

FACILITY NAME: PARKVIEW, THE	FACILITY NUMBER: 015601283
	VISIT DATE: 02/07/2025

NARRATIVE

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On 7/30/2024 LPA collected R1’s admission agreement, physician’s report, and care plans. R1 was admitted to the facility at a level 2 in assisted level. A level 2 states that the resident requires minimum assistance. Between 9/7/2023 and 7/9/2024 R1 had a total of eleven (11) documented falls while at the community. On 12/20/2024 LPA interviewed the ED who stated that due to the increase of R1’s falls and observations made of R1 while evaluating for return to the community that R1 required more assistance to return to the community. ED provided email correspondences with R1’s responsible party offering solutions for R1 to return to return to the community safely. However, R1’s responsible party and the facility did not come to a resolution for R1’s return. R1 was moved out from the facility on 08/09/2024. Based on interviews, file reviews, and email correspondence trying to find a safe way for R1 to return to the community the allegation “Facility is refusing to take resident back into care “ is unsubstantiated.

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

No deficiencies cited during visit. Exit interview conducted and a copy of this report provided.

SUPERVISOR'S NAME: Yvonne Flores-Larios	TELEPHONE: (510) -28-0517
LICENSING EVALUATOR NAME: Alona Gomez	TELEPHONE: 510-239-1306
LICENSING EVALUATOR SIGNATURE:	DATE: 02/07/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/07/2025

LIC9099 (FAS) - (06/04)

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