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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 331880982
Report Date: 12/09/2024
Date Signed: 12/09/2024 11:48:48 AM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
, CA 92507
This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/30/2024 and conducted by Evaluator Melody Brown
PUBLIC
COMPLAINT CONTROL NUMBER: 56-AS-20240430091544
FACILITY NAME:PARKVIEW RESIDENTIAL CAREFACILITY NUMBER:
331880982
ADMINISTRATOR:DURRANI, SULAIMANFACILITY TYPE:
735
ADDRESS:102 PARKVIEW DRIVETELEPHONE:
(714) 854-5596
CITY:CALIMESASTATE: CAZIP CODE:
92320
CAPACITY:4CENSUS: 1DATE:
12/09/2024
UNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Michael Jason Camarillo TIME COMPLETED:
11:55 AM
ALLEGATION(S):
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Staff do not have planned activities for a client.
Staff did not meet a client's hygiene needs.
INVESTIGATION FINDINGS:
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On 12/09/2024 at 09:15 AM, Licensing Program Analyst (LPA) Melody Brown conducted an unannounced visit to the facility to deliver the findings of the above allegations. LPA Brown was greeted and granted entrance by a staff. Licensee/Administrator Sulaiman Durrani was contacted and informed of the visit and LPA Brown explained the purpose of the visit to Licensee/Administrator Durrani. Licensee/Administrator Durrani designated staff Camarillo to sign the report as Licensee/Administrator Durrani's unavailable for the visit. LPA Brown explained the purpose of today's visit to staff Camarillo.

The investigation was conducted by LPA Brown. The investigation consisted of file review, observations and interviews with relevant parties. The first allegation indicates Staff do not have planned activities for a client. During the investigation, LPA Brown obtained evidence to corroborate the allegation. Interview with Staff #2 (S2) indicated that they do not have planned activities for Client #1 (C1). Staff #3 (S3) reported to LPA Brown that due to C1's behavior, they cannot take C1 out for a walk but they have television (TV) for C1 to watch movie anytime C1 wants. ***Continuation in LIC9099C***
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Melody Brown
LICENSING EVALUATOR SIGNATURE:

DATE: 12/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/09/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 6
Control Number 56-AS-20240430091544
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
, CA 92507
FACILITY NAME: PARKVIEW RESIDENTIAL CARE
FACILITY NUMBER: 331880982
VISIT DATE: 12/09/2024
NARRATIVE
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Licensee/Administrator Durrani confirmed to LPA Brown as well that the facility does not have planned activities for C1 due to C1's behavior. Interview with C1 family member indicated that the facility does not have planned activities for C1 as C1 family member reported to LPA Brown that facility staff will let C1 watch the television (TV) in C1's bedroom the whole day and they do not take C1 outside the facility. During the facility visit on 05/02/2024, LPA Brown observed C1 exhibiting behavior as C1 yells, break things and does not listen to S2. Also, LPA Brown observed a working TV in C1's room.

The second allegation indicates that Staff did not meet a client's hygiene needs. Interviews with two (2) of three (3) staff indicated that they cannot meet C1's hygiene needs due to C1's behavior. Two (2) of three (3) staff informed LPA Brown that it was C1's family member that's giving C1 a bath daily at the facility. C1 family member revealed to LPA Brown that the staffs at the facility were not meeting C1's hygiene needs as C1 family member received a phone call from Staff #2 (S2) requesting C1 family member to give C1 a bath daily at the facility.

Based on observation and interviews, the allegation of Staff do not have planned activities for a client (Allegation #1), and Staff did not meet a client's hygiene needs (Allegation #2) are SUBSTANTIATED. A finding that the complaint is SUBSTANTIATED means that the allegations are valid because the preponderance of the evidence standard has been met.

An exit interview was conducted and a copy of this report, LIC9099, LIC9099D and Appeal Rights were discussed and provided to Michael Jason Camarillo.
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Melody Brown
LICENSING EVALUATOR SIGNATURE:

DATE: 12/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/09/2024
LIC9099 (FAS) - (06/04)
Page: 6 of 6
Control Number 56-AS-20240430091544
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
, CA 92507

FACILITY NAME: PARKVIEW RESIDENTIAL CARE
FACILITY NUMBER: 331880982
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/09/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/16/2024
Section Cited
CCR
85079(a)(2)
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85079 Activities (a) The licensee shall ensure that planned recreational activities, which include the following, are provided... (2) Physical activities including but not limited to games, sports... This requirement is not met as evidenced by:
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Licensee stated to train all staff on CCR 85079(a)(2) and submit proof to LPA Brown by the Plan of Correction (POC) due date. Also, Licensee stated to submit a copy of the facility's planned activity to LPA Brown on POC due date.
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Based on observation, interview and records review, the licensee did not comply with the section cited above by not ensuring that planned recreation activities were provided to Client #1 (C1) which poses a potential health, safety or personal rights risk to persons 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.
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Melody Brown
LICENSING EVALUATOR SIGNATURE:

DATE: 12/09/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/09/2024
LIC9099 (FAS) - (06/04)
Page: 5 of 6
Control Number 56-AS-20240430091544
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
, CA 92507

FACILITY NAME: PARKVIEW RESIDENTIAL CARE
FACILITY NUMBER: 331880982
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/09/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
12/10/2024
Section Cited
CCR
80065(a)
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80065 Personnel Requirements (a) Facility personnel shall be competent to provide the services necessary to meet individual client needs and shall, at all times be employed...
This requirement was not met as evidenced by:
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Licensee stated that Staff #2 (S2) was terminated at the facility on 05/12/2024. Also, Licensee stated to train all staff on CCR 80065(a) and submit proof to LPA Brown by the Plan of Correction (POC) due date.
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Based on observation, interview and records review, the licensee did not comply with the section cited above by not ensuring that the staffs at the facility are meeting Client #1 (C1) hygiene needs which poses an immediate health, safety and personal rights risk to client 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.
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Melody Brown
LICENSING EVALUATOR SIGNATURE:

DATE: 12/09/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/09/2024
LIC9099 (FAS) - (06/04)
Page: 4 of 6
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
, CA 92507
This is an official report of an unannounced visit/investigation of a complaint received in our office on
04/30/2024 and conducted by Evaluator Melody Brown
COMPLAINT CONTROL NUMBER: 56-AS-20240430091544

FACILITY NAME:PARKVIEW RESIDENTIAL CAREFACILITY NUMBER:
331880982
ADMINISTRATOR:DURRANI, SULAIMANFACILITY TYPE:
735
ADDRESS:102 PARKVIEW DRIVETELEPHONE:
(714) 854-5596
CITY:CALIMESASTATE: CAZIP CODE:
92320
CAPACITY:4CENSUS: 1DATE:
12/09/2024
UNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Michael Jason Camarillo TIME COMPLETED:
11:55 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff do not ensure a client is properly fed.
INVESTIGATION FINDINGS:
1
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5
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8
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10
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13
On 12/09/2024 at 09:15 AM, Licensing Program Analyst (LPA) Melody Brown conducted an unannounced visit to the facility to deliver the findings of the above allegation. LPA Brown was greeted and granted entrance by a staff. Licensee/Administrator Sulaiman Durrani was informed of the visit and LPA Brown dicuissed the purpose of today's visit to Licensee/Administrator Durrani. Licensee/Administrator Durrani designated staff Camarillo to sign the report as Licensee/Administrator Durrani's unavailable for the visit. LPA Brown explained the purpose of today's visit to staff Camarillo..

The investigation was conducted by LPA Brown. The investigation consisted of file review, observations and interviews with relevant parties. The allegation indicates Staff do not ensure a client is properly fed. During the investigation, LPA Brown did not find evidence to corroborate the allegation. Interview with three (3) of three (3) staff indicated that they are ensuring that Client #1 (C1) was provided food and properly fed. During the visit on 05/02/2024, LPA Brown observed C1 eating the food provided by Staff #2 (S2) in C1's room. ***Continuation in LIC9099C***
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Melody Brown
LICENSING EVALUATOR SIGNATURE:

DATE: 12/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/09/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 6
Control Number 56-AS-20240430091544
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1650 SPRUCE ST STE 200 MS29-27
, CA 92507
FACILITY NAME: PARKVIEW RESIDENTIAL CARE
FACILITY NUMBER: 331880982
VISIT DATE: 12/09/2024
NARRATIVE
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Also, Licensee/Administrator Durrani provided the facility menu to LPA Brown on 05/02/2024.

Based on interviews, records review and observation, the allegation Staff do not ensure a client is properly fed is UNSUBSTANTIATED. A finding of unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur.

An exit interview was conducted, where this report (LIC9099) was discussed and provided to staff Michael Jason Camarillo.

SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Melody Brown
LICENSING EVALUATOR SIGNATURE:

DATE: 12/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/09/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 6