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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 331880982
Report Date: 10/31/2023
Date Signed: 10/31/2023 01:14:17 PM

Document Has Been Signed on 10/31/2023 01:14 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, 1650 SPRUCE ST STE 200 MS29-27
, CA 92507
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: 2DATE:
10/31/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:26 AM
MET WITH:Calvin Refundy Support StaffTIME COMPLETED:
01:30 PM
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Licensing Program Analysts (LPA's) Bernadette Allen made an unannounced visit to the facility to conduct an annual inspection. At the time of the visit there was one (1) staff and there was one (1) resident.

The facility is an Adult Residential Facility (ARF) with six (6) bedrooms, three (3) bathrooms in the home, LPA observed kitchen/dining area, living room and a family/dining area. LPA conducted an overall inspection of the facility, which included, but was not limited to, the following:

The Indoor and outdoor passageways were kept free of obstruction. The facility has sufficient furniture and lighting and is maintained at a comfortable temperature.

There was enough nonperishable and perishable food for the number of residents in care. The facility has a variety of food available for residents, and menus posted. The facility food is stored in a safe and healthful manner. Sharps are stored and locked in a toolbox in the pantry inaccessible to clients in care.

The master bedroom is used for the office and one bedroom is used for the staff. The resident’s bedrooms are equipped with required furniture such as: mattresses, night stands, storage space, and sufficient lighting. All bathrooms were operating in a safe and sanitary conditions. The hot water temperature measured between 105- and 120 degrees F. LPA also observed the facility is equipped with operating carbon monoxide/smoke detectors and fully charged fire extinguishers.

Posters such as personal rights and the disaster plan were posted in a common area.

LPA observed cleaning supplies, toxins items are kept in a locked cabinet in the garage and is inaccessible to clients in care. The staff and resident’s files were reviewed, and all files had the required documents at the time of the visit. Based on the observations made during today’s visit, no deficiencies were cited per Title 22, Division 6, of the California Code of Regulations.

An exit interview was conducted, and this report was discussed and provided to Calvin Rifandy at the conclusion of the visit.

SUPERVISORS NAME: Karen Clemons
LICENSING EVALUATOR NAME: Bernadette Allen
LICENSING EVALUATOR SIGNATURE: DATE: 10/31/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/31/2023
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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