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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005798
Report Date: 03/05/2024
Date Signed: 03/05/2024 10:15:39 AM


Document Has Been Signed on 03/05/2024 10:15 AM - 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, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868



FACILITY NAME:PARK VIEW ESTATESFACILITY NUMBER:
306005798
ADMINISTRATOR:ROBERT A. JAKINIFACILITY TYPE:
740
ADDRESS:11360 WARNER AVE.TELEPHONE:
(949) 333-3486
CITY:FOUNTAIN VALLEYSTATE: CAZIP CODE:
92708
CAPACITY:150CENSUS: 104DATE:
03/05/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
08:50 AM
MET WITH:Jamie Pyles, Health Service Director and Sacha Dunlap, Business Office Manager and Marissa Drinkhouse-QuintanaTIME COMPLETED:
10:15 AM
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This unannounced Case Management – Incident inspection is being conducted by Licensing Program Analyst (LPA) Rosie Quiroz for the purpose of a health and safety check and to follow up on a self-reported incident report received in the Orange County Regional Office (OCRO) on 03/05/24 regarding an incident involving Staff 1 #1 (S1). LPA was greeted by front desk receptionist and met with Jamie Pyles, Health Service Director (HSD) and Sacha Dunlap, Business Office Manager (BOM). LPA Quiroz called and spoke to Administrator (AD) Marissa Drinkhouse-Quintana and discussed the purpose of the inspection visit.

During today’s inspection, LPA Quiroz along with (HSD) Jamie Pyles toured the interior and exterior of the facility premises and observed multiple staff and residents present throughout today's inspection tour. LPA conducted health and safety checks on the residents present and observed no imminent health and safety concerns. LPA observed the facility to be clean and organized and found no health and safety issues. LPA observed the facility has a 2-day supply of perishables and a 7-day supply of non-perishable food is available as required by regulations, the electricity and water were running, the facility had soap and paper towels, and the medications, sharps, and toxins were properly stored.

LPA Quiroz interviewed (AD) Drinkhouse-Quintana via telephone who indicated Ombudsman and local police department were notified of incident. LPA Quiroz was provided with cross reporting case number to Fountain Valley Police Department.

There were no health and safety concerns observed in the areas inspected.

Based on the observations made during today’s inspection, no deficiencies are being cited per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted with (HSD) Pyles and a copy of this report was discussed and provided at exit.

SUPERVISOR'S NAME: Alisa OrtizTELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Rosie QuirozTELEPHONE: (559) 753-4610
LICENSING EVALUATOR SIGNATURE:
DATE: 03/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/05/2024
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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