198603545-7-9-2024-28-AS-TVAO-D7FLJE-20240723084746

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 198603545
Report Date: 07/09/2024
Date Signed: 07/09/2024 12:03:15 PM

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
07/01/2024 and conducted by Evaluator Cynthia D Chan

PUBLIC

COMPLAINT CONTROL NUMBER: 28-AS-20240701133013

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: 64	DATE:	07/09/2024
		UNANNOUNCED	TIME BEGAN:	08:53 AM
MET WITH:	Lee Ann Hefner, Executive Director		TIME COMPLETED:	12:15 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Illegal eviction

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst (LPA) Cynthia Chan conducted a complaint investigation on the allegation listed above. LPA arrived unannounced and met with Executive Director, Lee Ann Hefner. The purpose of the visit was explained.

LPA obtained a copy of the staff roster, resident roster, and documents pertaining to Resident #1. LPA interviewed the Executive Director, Wellness Director, and family member.

For the allegation of an illegal eviction, LPA conducted interviews and reviewed documents to determine findings. Per the Executive Director, an eviction letter was never issued to Resident #1 (R-1). R-1 moved into the facility on 6/1/24. On 6/3/24, the facility contacted 911 because R-1 was displaying chest pain due to the aggressive behavior.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Tony Vasallo	TELEPHONE: (323) 981-3977
LICENSING EVALUATOR NAME: Cynthia D Chan	TELEPHONE: (323) 981-3370
LICENSING EVALUATOR SIGNATURE:	DATE: 07/09/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/09/2024

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 28-AS-20240701133013

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: 07/09/2024

NARRATIVE

1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32

R-1 was sent out to the hospital and when ready for discharge, R-1’s daughter moved resident back to own home with the one-on-one caregiver. Per the Executive Director and Wellness Director, they denied telling the hospital staff they were not accepting the resident back as alleged. LPA reviewed the facility documents which showed that the Wellness Director conducted a reassessment of R-1 on 6/5/24 at R-1’s private home. The Wellness Director also stated that R-1’s daughter was informed of the change in level of care and understood the cost will increase. Staff was told that R-1 was coming back to the facility after the weekend. However, the family came on the weekend to move out all of the belongings without informing any staff. LPA interviewed R-1’s family member, who heard from a hospital personnel that the facility was not accepting resident back but did not confirm with the Executive Director if information was true. Based on the information gathered, there is insufficient evidence to support this allegation of the illegal eviction.

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.

An exit interview was conducted with the Executive Director. A copy of this report along with the appeal rights were provided.

SUPERVISOR'S NAME: Tony Vasallo	TELEPHONE: (323) 981-3977
LICENSING EVALUATOR NAME: Cynthia D Chan	TELEPHONE: (323) 981-3370
LICENSING EVALUATOR SIGNATURE:	DATE: 07/09/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/09/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 2