197609084-7-9-2021-28-AS-FFIS-C4S2CG-20210709171644

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 197609084
Report Date: 07/09/2021
Date Signed: 07/09/2021 01:25:04 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

This is an official report of an unannounced visit/investigation of a complaint received in our office on
01/06/2020 and conducted by Evaluator Bonnie Tao

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20200106164039

FACILITY NAME:	PARKVIEW OF GLENDALE		FACILITY NUMBER:	197609084
ADMINISTRATOR:	WILKENS, DAVID		FACILITY TYPE:	740
ADDRESS:	426 PIEDMONT AVE		TELEPHONE:	(925) 377-5197
CITY:	GLENDALE	STATE: CA	ZIP CODE:	91206
CAPACITY:	0	CENSUS:	DATE:	07/09/2021
		UNANNOUNCED	TIME BEGAN:	01:00 PM
MET WITH:			TIME COMPLETED:	01:30 PM

ALLEGATION(S):

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9

Facility failed to protect resident's personal properly.
Facility inappropriately administered resident's medication.

INVESTIGATION FINDINGS:

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On 01/15/2020, Licensing Program Analyst (LPA) Shawna Day conducted an initial complaint visit. LPA interviewed staff and reviewed resident file.

Thus, the investigation revealed that there was insufficient information to support the above mentioned allegations and although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegation is unsubstantiated.

No deficiencies were noted during 01/15/2020 complaint visit per Title 22 Division 6 Chapter 8. Exit interview was conducted.

PARKVIEW OF GLENDALE, RCFE, was closed on 12/03/2020, therefore a copy of the LIC 9099 report dated 07/09/2021 was mailed to the Licensee's mailing address via certified mail on 7/12/2021 and emailed to Licensee's email address on 7/9/2021.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Fernando Fierros	TELEPHONE: (323) 981-3981
LICENSING EVALUATOR NAME: Bonnie Tao	TELEPHONE: (323) 981-3971
LICENSING EVALUATOR SIGNATURE:	DATE: 07/09/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/09/2021

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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