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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 198603545
Report Date: 07/30/2024
Date Signed: 07/30/2024 05:04:55 PM


Document Has Been Signed on 07/30/2024 05:04 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
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 PLACEFACILITY NUMBER:
198603545
ADMINISTRATOR:LEEANN HEFNERFACILITY TYPE:
740
ADDRESS:1054 PARK VIEW DRIVETELEPHONE:
(626) 885-1800
CITY:COVINASTATE: CAZIP CODE:
91724
CAPACITY:142CENSUS: 62DATE:
07/30/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:00 AM
MET WITH:Lee Ann Hefner, administratorTIME COMPLETED:
05:00 PM
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Licensing Program Analyst (LPA) Tao conducted an unannounced annual inspection visit to the facility. LPA met Lee Ann Hefner, administrator and the purpose of today's inspection was explained. The facility is licensed to serve age range 60 and over, approved for (142) non-ambulatory, including eight (8) may be bedridden. Delayed egress was approved. The facility had approved hospice waiver for twelve (12) for residents residing in bedrooms# 101,102,103,104,121,122,123, and 124.

LPA conducted staff/resident interviews, used CARE inspection tool, conducted physical plant, reviewed food supply/medications and records/ staff/residents’ records. Facility fees were current. Administrator certificate was current until 3/29/25.

The building was a three-story building which was consisted of a front lobby, memory care unit, common areas, resident rooms and private bathrooms, public bathrooms, dining rooms, central restaurant style kitchen, offices, housekeeping closets, activity rooms, bar area, beauty salon, theater room, laundry and linen storage and supply rooms, and medication rooms. The memory care unit was located on the first floor. A delayed egress door system and alarm system were operational. The signal system were tested and staff arrived within 8 mins. Physical plant was conducted in room 114, 117, 135, 230, 224, and 327. Residents’ bedrooms and bathrooms were in compliance. Hot water temperature was measured in a range of 114.2 to 115.1 degrees Fahrenheit which was within Title 22 Regulation guidelines. Landline telephone systems were operational and available for resident use. Smoke/carbon monoxide detectors were monitored by a fire alarm company and last service was on 5/10/24. Fire extinguishes were fully charged.
(-continued on LIC 809 C-)
SUPERVISOR'S NAME: Fernando FierrosTELEPHONE: (323) 981-3981
LICENSING EVALUATOR NAME: Bonnie TaoTELEPHONE: (323) 981-3971
LICENSING EVALUATOR SIGNATURE:
DATE: 07/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/30/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: 07/30/2024
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Sufficient supply of perishable and non-perishable foods was observed. A comfortable temperature of 75 degrees Fahrenheit maintained throughout the entire facility. No bodies of water observed. Staff and resident files will be kept in the director's office on the second floor. Elevators for residents' use were operational.

Per California Code of Regulations, Title 22, there were no deficiencies observed during the visit. Exit interview was held. A copy of the report was provided.
SUPERVISOR'S NAME: Fernando FierrosTELEPHONE: (323) 981-3981
LICENSING EVALUATOR NAME: Bonnie TaoTELEPHONE: (323) 981-3971
LICENSING EVALUATOR SIGNATURE:

DATE: 07/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/30/2024
LIC809 (FAS) - (06/04)
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