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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 331880982
Report Date: 12/17/2024
Date Signed: 12/17/2024 12:05:58 PM

Unsubstantiated


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
05/23/2024 and conducted by Evaluator Melody Brown
PUBLIC
COMPLAINT CONTROL NUMBER: 56-AS-20240523123234
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:
12/17/2024
UNANNOUNCEDTIME BEGAN:
11:15 AM
MET WITH:Michael Jason Camarillo TIME COMPLETED:
12:15 PM
ALLEGATION(S):
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Client sustained unexplained injuries while in care.
Staff engaged in an altercation with client in care.
Staff did not provide proper medication assistance to client in care.
Staff did not keep the facility free of mold.
INVESTIGATION FINDINGS:
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On 12/17/2024 at 11:15 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 Michael Jason 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 Client sustained unexplained injuries while in care. During the investigation, LPA Brown did not find evidence to corroborate the allegation. Interviews with two (2) of two (2) staff denied Client #1 sustaining unexplained injuries while in care. Interview with Staff #2 (S2) indicated that due to Client #1 (C1) aggressive behavior on 05/17/2024, S2 had to restrain C1 for emergency intervention as S2 can no longer control or prevent C1 aggressive behavior.*Cont.in LIC9099C*
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Melody Brown
LICENSING EVALUATOR SIGNATURE:

DATE: 12/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/17/2024
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 3
Control Number 56-AS-20240523123234
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: 12/17/2024
NARRATIVE
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Interview with two (2) of two (2) staff indicated that they are not aware that C1 sustained injury on 05/17/2024. In addition, two (2) of two (2) staff reported to LPA Brown that it was S2 who sustained a fist size bruise on S2's leg and bite mark on S2's hand. Interviews with two (2) of two (2) staff revealed that S1 had to call the local law enforcement for C1's uncontrollable aggressive behavior. Interview with Client #2 (C2) indicated that C2 did not see or witness C1 sustaining injuries while C1 was at the facility.

The second allegation indicates Staff engaged in an altercation with client in care. Interview with C2 indicated that C2 did not see a staff engaging in altercation or fight with C1. Interview with Staff #2 (S2) indicated that due to Client #1 (C1) aggressive behavior on 05/17/2024, S2 had to restrain C1 for emergency intervention as S2 can no longer control or prevent C1 aggressive behavior. Interview with two (2) of two (2) staff indicated that they were both denying the allegation that a staff engaged in altercation with C1. Two (2) of two (2) staff informed LPA Brown that Staff #1 (S1) had to call law enforcement for C1's uncontrollable behavior towards S2. Records review indicated that the facility submitted to Community Care Licensing Division (CCLD) an Unusual Incident/Injury Report (LIC624) on 05/17/2024. Per records review, LPA Brown noted that the local law enforcement did not initiate 5150 detention on C1 due to C1's family member arrived first at the facility and informed the local law enforcement that they will take C1 home.

The third allegation indicates Staff did not provide proper medication assistance to client in care. During the investigation, LPA Brown did not find evidence to corroborate the allegation. Interview with C2 indicated that staff at the facility are giving C2 medications daily and there's no incident that a staff at the facility missed giving C2 medications. Interview with two (2) of two (2) staff indicated that they are assisting their clients with their medications as prescribed by their physician. Two (2) of two (2) staff interviewed reported to LPA Brown that they are assisting C1 with C1 medications everyday and no incident happened that they did not assist C1 with C1's medications. During the visit on 12/09/2024, LPA Brown reviewed C1 Medication Administration Record (MAR) and LPA Brown observed that the staffs at the facility are assisting C1 with C1's medications.

The fourth allegation indicates staff did not keep the facility free of mold. During the investigation, LPA Brown did not find evidence to corroborate the allegation. Interview with C2 indicated that there's no mold at the facility. Also, C2 informed LPA Brown that staffs at the facility are ensuring that the facility's clean everyday. Interview with two (2) of two (2) staff indicated that there's no mold at the facility and they make sure that the facility's clean daily. **Continuation in LIC9099C***
SUPERVISORS NAME: Efren Malagon
LICENSING EVALUATOR NAME: Melody Brown
LICENSING EVALUATOR SIGNATURE:

DATE: 12/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/17/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 56-AS-20240523123234
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: 12/17/2024
NARRATIVE
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During the facility visit on 05/28/2024, 12/09/2024 and 12/17/2024, LPA Brown did not observe mold at the facility. LPA Brown noted that the staff keeps the facility clean everyday.

Based on interviews, records review and observation, the allegations client sustained unexplained injuries while in care (Allegation #1), staff engaged in an altercation with client in care (Allegation #2), staff did not provide proper medication assistance to client in care (Allegation #3), staff did not keep the facility free of mold (Allegation #4) are 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: 12/17/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/17/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 3