306005798-3-26-2026-22-AS-AORZ-DSNT4M-20260330142410

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 306005798
Report Date: 03/26/2026
Date Signed: 03/26/2026 02:02:07 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/21/2022 and conducted by Evaluator Samer Haddadin

COMPLAINT CONTROL NUMBER: 22-AS-20220421153926

FACILITY NAME:	PARK VIEW ESTATES		FACILITY NUMBER:	306005798
ADMINISTRATOR:	HEATHER MYERS		FACILITY TYPE:	740
ADDRESS:	11360 WARNER AVE.		TELEPHONE:	(949) 333-3486
CITY:	FOUNTAIN VALLEY	STATE: CA	ZIP CODE:	92708
CAPACITY:	170	CENSUS: 153	DATE:	03/26/2026
		UNANNOUNCED	TIME BEGAN:	12:15 PM
MET WITH:	Executive Director (ED) Peggy Ulland		TIME COMPLETED:	02:45 PM

ALLEGATION(S):

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Staff did not isolate resident with COVID
Resident experienced several falls due to neglect
Resident has scabies
Resident has ringworm
Staff are mismanaging residents’ medications

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Samer Haddadin conducted an unannounced visit to the facility to investigate the above-mentioned allegations. Upon arrival, LPA Haddadin was greeted and granted entry by Executive Director (ED) Peggy Ulland. The purpose of the visit was explained. The investigation included staff and resident interviews, record reviews, and direct observations of the physical plant.
The allegations investigated were: “Staff did not isolate resident with COVID,” , “Resident experienced several falls due to neglect,”, “Resident has scabies,” “Resident has ringworm,” and “Staff are mismanaging residents’ medications,” During the investigation, the LPA was able to obtain and review physician report and progress notes for Resident 1 (R1). Regarding the allegation that staff did not properly isolate a resident with COVID-19, LPA reviewed R1’s progress notes dated January 11, 2022 which documented that R1 was placed in isolation after testing positive for COVID-19.

Unsubstantiated

Estimated Days of Completion:

SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Samer Haddadin
LICENSING EVALUATOR SIGNATURE:	DATE: 03/26/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/26/2026

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 22-AS-20220421153926

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: PARK VIEW ESTATES	FACILITY NUMBER: 306005798
	VISIT DATE: 03/26/2026

NARRATIVE

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The documentation further showed that staff provided meals to R1 during the quarantine period; however, R1 at times refused food and became verbally aggressive despite repeated staff efforts to provide assistance. In addition, LPA conducted five staff interviews and five resident interviews, and all individuals interviewed denied the allegation. LPA also confirmed through staff interviews and LPA observations that the facility maintains a supply of personal protective equipment (PPE) for use as needed. During record review, LPA verified that staff had received training on infection control procedures and protocols to follow in the event of an outbreak.
Regarding the allegation that the resident experienced several falls due to neglect, facility records reflected that on August 10, 2021, R1 was found by staff lying on their back in the hallway and complaining of back pain. The fall was unwitnessed. Out of precaution, the facility arranged for R1 to be transported to a local hospital for evaluation. According to the facility’s documentation, R1 did not sustain any fractures and was later discharged from the hospital. Per records reviewed there were no other falls documented for R1. LPA was unable to interview R1 due to R1 moving out of the facility.
Regarding the allegations that the resident had scabies and ringworm, LPA reviewed R1’s records and found no documentation confirming either diagnosis. Progress notes dated July 2, 2021, indicated that R1 developed a rash on the left ankle, which was treated as directed by the resident’s physician. All treatments were recorded by the facility’s Medication Technician. Five staff were interviewed and reported direct knowledge of R1 and reported R1 did not have any diagnosis of scabies or ringworm. Five residents were interviewed who reported they had no knowledge of residents in care having scabies or ringwork.
Regarding the allegation that staff mismanaged residents’ medications, LPA interviewed five staff members who handle resident medications who reported having no knowledge of R1’s medications being mismanaged. LPA interviewed five residents who denied having issues with medications not being received timely and/or receiving incorrect medications. LPA observed facility medication administration process during visits. incorrect medications. LPA observed facility medication administration process during visits.

SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Samer Haddadin
LICENSING EVALUATOR SIGNATURE:	DATE: 03/26/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/26/2026

LIC9099 (FAS) - (06/04)

Page: 3 of 3

Control Number 22-AS-20220421153926

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: PARK VIEW ESTATES	FACILITY NUMBER: 306005798
	VISIT DATE: 03/26/2026

NARRATIVE

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During the process LPA observed Medication Technicians matched each medication with the resident’s name, dosage, and photograph before dispensing.
Based on the investigation, there was insufficient evidence to prove that the alleged violations occurred. Therefore, the allegations: “Staff did not isolate resident with COVID,”, “Resident experienced several falls due to neglect,”, “Resident has scabies,” “Resident has ringworm,” and “Staff are mismanaging residents’ medications,” are deemed Unsubstantiated
An exit interview was conducted with Executive Director (ED) Peggy Ulland and a copy of this report was provided to the facility representative.

SUPERVISORS NAME: Alisa Ortiz
LICENSING EVALUATOR NAME: Samer Haddadin
LICENSING EVALUATOR SIGNATURE:	DATE: 03/26/2026

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/26/2026

LIC9099 (FAS) - (06/04)

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