<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 306005798
Report Date: 07/21/2023
Date Signed: 07/21/2023 03:19:48 PM


Document Has Been Signed on 07/21/2023 03:19 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: 103DATE:
07/21/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:45 PM
MET WITH:Robert Jakini, Executive DirectorTIME COMPLETED:
03:20 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On today's date, while conducting 10 day inspection visit regarding complaint control #22-AS-20230717085332, LPA Quiroz and Ombudsman Representative Linda Bock met with Executive Director (ED) Robert Jakini and explained the purpose of the Case Management-Other inspection visit to conduct Complaint investigation follow ups for the following complaint control #s:22-AS-20220525095746 and 22-AS-20221207111938.
During today's inspection visit, LPA Quiroz and Ombudsman Representative Bock along with (ED) Jakini toured the interior premises of Assisted Living and Memory Care Unit. During today's visit, LPA Quiroz and Ombudsman Representative Bock conducted interviews with interviewees and conducted facility observations throughout today's facility inspection visit.

An exit interview was conducted with (ED) Jakini and a copy of this report was provided to (ED) Jakini.
SUPERVISOR'S NAME: Alisa OrtizTELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Rosie QuirozTELEPHONE: (559) 753-4610
LICENSING EVALUATOR SIGNATURE:
DATE: 07/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/21/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1