198603545-4-29-2025-28-AS-RORN-DGEV38-20250506160420

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603545
Report Date: 04/26/2025
Date Signed: 04/29/2025 10:24:28 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 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
02/06/2025 and conducted by Evaluator Kimberly Ramirez

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20250206102807

FACILITY NAME:	PARK VIEW PLACE		FACILITY NUMBER:	198603545
ADMINISTRATOR:	LEEANN HEFNER		FACILITY TYPE:	740
ADDRESS:	1054 PARK VIEW DRIVE		TELEPHONE:	(626) 885-1800
CITY:	COVINA	STATE: CA	ZIP CODE:	91724
CAPACITY:	142	CENSUS: 94	DATE:	04/26/2025
		UNANNOUNCED	TIME BEGAN:	04:44 PM
MET WITH:	Health and Wellness Director Alicia Aragon		TIME COMPLETED:	05:15 PM

ALLEGATION(S):

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Resident sustained a fracture due to staff neglect.
Staff did not prevent physical altercation between residents.
Staff did not meet resident's incontinence needs.
Staff did not provide resident with clean linen.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Kimberly Ramirez conducted an unannounced subsequent complaint investigation visit on 04/26/2025 to deliver findings regarding the above allegations. LPA Villalobos conducted a Health & Safety visit on 02/06/2025 and a needs further investigation was documented. During today’s visit, LPA Ramirez was greeted by Alicia Aragon and explained the purpose of the visit.

The investigation consisted of the following: LPA Ramirez requested and obtained copies of Resident/Client Roster, Staff Roster, Interviews conducted by Community Care Licensing-Investigations Branch, Staff interviews#1-5 (S1-S5) conducted by LPA Ramirez, Attempted interview of resident#1 (R1) by LPA Ramirez, Attempted interview of R1’s responsible party by LPA Ramirez, Copies of R1’s: Physician’s Medical Assessment (LIC 602A), Admission Agreement, Staff charting notes for R1, and physical plant tour.

See 9099-C

Unsubstantiated

Estimated Days of Completion:

NAME OF LICENSING PROGRAM MANAGER: Tony Vasallo
NAME OF LICENSING PROGRAM ANALYST: Kimberly Ramirez
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 04/26/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/26/2025

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 28-AS-20250206102807

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
GREATER LA AC/SC, 1000 CORPORATE CNTR DR. ST 500
MONTEREY PARK, CA 91754

FACILITY NAME: PARK VIEW PLACE	FACILITY NUMBER: 198603545
	VISIT DATE: 04/26/2025

NARRATIVE

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The investigation revealed the following: regarding the allegation(s)- Resident sustained a fracture due to staff neglect. It is alleged that R1 sustained a fracture due to staff neglect on 12/16/2024. Interviews conducted by Community Care Licensing-Investigations Branch did not corroborate this allegation. Review of R1’s resident records by Community Care Licensing-Investigations Branch did not corroborate this allegation. 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.

Staff did not prevent physical altercation between residents. It is alleged that facility staff did not prevent physical altercation between R1 and R2 on 12/16/2024. Interviews conducted by Community Care Licensing-Investigations Branch did not corroborate this allegation. Review of R1’s resident records by Community Care Licensing-Investigations Branch did not corroborate this allegation. 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.

Staff did not meet resident's incontinence needs. It is alleged that staff did not meet R1’s incontinence needs. Five (5) out of the five (5) staff interviewed by LPA Ramirez did not corroborate this allegation. LPA Ramirez attempted to interview R1 but, R1 was unavailable for an interview. LPA Ramirez attempted to contact R1’s responsible party but, R1’s responsible party was not available for an interview. Review of R1’s resident record by LPA Ramirez did not corroborate this allegation. During tour of facility, LPA Ramirez observed residents to be well groomed and not malodorous. 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.

Staff did not provide resident with clean linen. It is alleged that facility staff did not provide R1 with clean linen. Five (5) out of the five (5) staff interviewed by LPA Ramirez did not corroborate this allegation. LPA Ramirez attempted to interview R1 but, R1 was unavailable for an interview. LPA Ramirez attempted to contact R1’s responsible party but, R1’s responsible party was not available for an interview. Review of R1’s resident record by LPA Ramirez did not corroborate this allegation. During tour of facility, LPA Ramirez observed resident rooms to be free from malodorous and observed sufficient supply of extra clean linen in laundry room. 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 violations were cited for this complaint investigation. Exit interview was conducted. A copy of this report was provided via email.

NAME OF LICENSING PROGRAM MANAGER: Tony Vasallo
NAME OF LICENSING PROGRAM ANALYST: Kimberly Ramirez
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 04/26/2025

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/26/2025

LIC9099 (FAS) - (06/04)

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