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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005798
Report Date: 04/18/2024
Date Signed: 04/18/2024 04:51:12 PM


Document Has Been Signed on 04/18/2024 04:51 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, 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: 112DATE:
04/18/2024
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
04:21 PM
MET WITH:Jamie Pyles, Health and Wellness Directorn and Sasha Dunlap, Business Office ManagerTIME COMPLETED:
04:55 PM
NARRATIVE
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On today's date, Licensing Program Analysts (LPAs) LPA Rosie Quiroz and LPA Rose Ruppert conducted a subsequent unannounced visit after conducting 10 day visit for complaint control # 22-AS-20240411095716.
LPAs met with Health and Wellness Director (HWD) Jamie Pyles and discussed purpose of the visit.
On or about 3:10pm while conducting interviews with residents in Activity room, LPA Quiroz observed temperature in activity room to be 80 degrees fahrenheit and observed temperature gage to be locked. At 3:20pm, the temperature was observed to increase to 82 degrees Fahrenheit, this was verified with Activity Director who indicated "Temperature is controlled from Marketing not here." On or about 3:55pm, Maintenance Director Matt Yem arrived to activity room to decrease room temperature. At 4:17pm, the temperature was recorded to be 78 degrees fahrenheit. Ten of ten interviewees indicated "the activity room is always hot and not of comfortable temperature."

During today's inspection visit, while conducting tour of the facility and conducting interviews for complaint control # 22-AS-20240411095716 the following deficiency was observed and is being cited via this case management deficiency.

87303(b):Maintenance and Operation
(b) A comfortable temperature for residents shall be maintained at all times.

The facility is being cited per Title 22, Division 6 of the California Code of Regulations. An exit interview was conducted with HWD Jamie Pyles, and a copy of this report, 809-D Page, Appeal Rights were provided at exit.
SUPERVISOR'S NAME: Alisa OrtizTELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Rosie QuirozTELEPHONE: (559) 753-4610
LICENSING EVALUATOR SIGNATURE:
DATE: 04/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/18/2024
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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Document Has Been Signed on 04/18/2024 04:51 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		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 ESTATES
FACILITY NUMBER: 306005798

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 04/18/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/25/2024
Section Cited
CCR
87303(b)

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87303(b)-Maintenance and Operation :
(b) A comfortable temperature for residents shall be maintained at all times. This requirement was not met as evidenced by: On or about 3:10pm while conducting interviews with residents in Activity room, LPA Quiroz observed temperature in activity
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HWD agreed temperature in activity room is at a comfortable temperature prior to holding Activity and provide training on 87303 to all staff and submit proof of training by 4/25/2024.
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room to be 80 degrees fahrenheit and observed temperature gage to be locked. At 3:20pm, Temperature was observed to increase to 82 degrees Fahrenheit, this was verified with Activity Director who indicated "Temperature is controlled from Marketing not here." On or about 3:55pm, Maintenance Director CONT...
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CONT... Matt Yem arrived to activity room to decrease room temperature. At 4:17pm, the temperature was recorded to be 78 degrees fahrenheit. Ten of ten interviewees indicated the activity room is always hot and not of comfortable temperature. This poses a potential risk to residents in care.

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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: Alisa OrtizTELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Rosie QuirozTELEPHONE: (559) 753-4610
LICENSING EVALUATOR SIGNATURE:
DATE: 04/18/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/18/2024
LIC809 (FAS) - (06/04)
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