198603545-7-18-2023-28-AS-RORN-CV8UTY-20230831155242

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603545
Report Date: 07/18/2023
Date Signed: 07/18/2023 03:12:29 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, 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
07/13/2023 and conducted by Evaluator Bonnie Tao

COMPLAINT CONTROL NUMBER: 28-AS-20230713105738

FACILITY NAME:	PARK VIEW PLACE		FACILITY NUMBER:	198603545
ADMINISTRATOR:	GUSTIN, PATRICIA		FACILITY TYPE:	740
ADDRESS:	1054 PARK VIEW DRIVE		TELEPHONE:	(626) 885-1800
CITY:	COVINA	STATE: CA	ZIP CODE:	91724
CAPACITY:	142	CENSUS: 48	DATE:	07/18/2023
		UNANNOUNCED	TIME BEGAN:	09:00 AM
MET WITH:	Patricia Gustin, administrator		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

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Administrator is not fulfilling administrative duties and quailfication.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Tao conducted unannounced complaint investigation for the allegation listed above today. During today’s visit, LPA met Administrator, Patricia Gustin. LPA explained the purpose of today's visit regarding the above-mentioned allegation.

Investigation consisted of the following: interviews of staff from Staff #1 (S1) through Staff #4 (S4); interviews of residents from Resident#1 (R1) through Resident#5 (R5); interviews of visitors from visitor #1 (V1) to visitor #3 (V3); reviewed staff's training record, and conducted a facility tour. LPA obtained copies of staff/resident rosters; and staff training files with relevant information.

The investigation revealed that regarding allegation, “Administrator is not fulfilling administrative duties and qualification,” it was alleged that administrator did not present enough hours to operate the facility, did not provide the required training to staff, and administrator’s certificate was not current.
(-continued in LIC 9099 C-)

Substantiated

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: 07/18/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2023

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-20230713105738

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: PARK VIEW PLACE	FACILITY NUMBER: 198603545
	VISIT DATE: 07/18/2023

NARRATIVE

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The investigation revealed the following: interviewed with residents from R1 to R5, all five (5) out of five (5) residents interviewed revealed that administrator had present enough hours at the facility and staff had the knowledge on taking care of residents. Interviewed with visitors from V1 to V3, all visitors interviewed revealed that administrator had present enough hours at the facility and staff knew how to take care of the residents. Four (4) out of four (4) staff interviewed and denied the allegation. LPA conducted a file review. File review revealed that administrator had present at least 40 hours/ week at the facility and staff’s in-services training were current. However, administrator certificate was not current and expired on 6/8/23. Administrator stated the certificate renewal was in process and the expected completion day would be the end of August 2023. Therefore, facility did not have a qualified and currently certified administrator.

Based on LPA's observations, record reviews and interviews conducted the preponderance of evidence standard has been met, therefore the above allegations are found SUBSTANTIATED.

Deficiencies are being cited according to California Code of Regulations, Title 22, Division 6, Chapter 8 on LIC 9099D.

An exit interview was conducted with Administrator. A hard copy of this report and appeal right were provided.

SUPERVISOR'S NAME: Fernando Fierros	TELEPHONE: (323) 981-3981
LICENSING EVALUATOR NAME: Bonnie Tao	TELEPHONE: (323) 981-3971
LICENSING EVALUATOR SIGNATURE:	DATE: 07/18/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2023

LIC9099 (FAS) - (06/04)

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Control Number 28-AS-20230713105738

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

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

FACILITY NAME: PARK VIEW PLACE	FACILITY NUMBER: 198603545
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 07/18/2023

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Deficiency Dismissed Type B 08/28/2023 Section Cited CCR 87405(a)	1 2 3 4 5 6 7	(a) All facilities shall have a qualified and currently certified administrator. This requirement was not met by evidence of: Per staff record review, administrator certificate was expired on 6/8/23 and did not have a current certificate.	1 2 3 4 5 6 7	Administrator is working on renewing administrator certificate and agreed to provide a copy of the certificate to Licensing by POC date 8/28/23.
	8 9 10 11 12 13 14	Based on interviews and observation, the Administrator did not comply with the section cited above which poses a potential health, safety or personal rights risk to persons in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Fernando Fierros	TELEPHONE: (323) 981-3981
LICENSING EVALUATOR NAME: Bonnie Tao	TELEPHONE: (323) 981-3971
LICENSING EVALUATOR SIGNATURE:	DATE: 07/18/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2023

LIC9099 (FAS) - (06/04)

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