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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005798
Report Date: 04/11/2023
Date Signed: 04/11/2023 10:01:14 AM


Document Has Been Signed on 04/11/2023 10:01 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: 121DATE:
04/11/2023
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME BEGAN:
09:26 AM
MET WITH:Robert Jakini, AdministratorTIME COMPLETED:
10:00 AM
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On today's date, Licensing Program Analysts (LPAs) Rosie Quiroz and Alvaro Ramirez conducted an unannounced case management health and safety check visit to facility in conjunction with complaint: 22-AS-20230410115728.

LPAs Quiroz and Ramirez were greeted and granted entry by front desk concierge. LPAs met with Administrator (AD) Robert Jakini and discussed purpose of today's visit. During today's visit, LPAs conducted a tour of the Memory care and Assisted living area.

There are currently 121 residents in care of which 37 residents are residing in memory care and 84 residents are residing in Assisted Living. There are currently 11 residents on hospice care at this time.

During today's visit, the residents were observed in dining-room areas eating breakfast with staff supervision and those residents residing in Assisted Living are were observed to be walking through out facility.

LPAs Quiroz and Ramirez did not observe any hazards or safety concerns that poses a threat on the health and safety of residents in care.

For this visit, no deficiencies were issued. No citations issued at this time.

LPAs Quiroz and Ramirez conducted an exit interview with (AD) Robert Jakini and provided and a copy of this report at exit.
SUPERVISOR'S NAME: Alisa OrtizTELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Rosie QuirozTELEPHONE: (559) 753-4610
LICENSING EVALUATOR SIGNATURE:
DATE: 04/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/11/2023
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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