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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374603713
Report Date: 11/02/2020
Date Signed: 11/02/2020 06:02:09 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108
FACILITY NAME:PARKVIEW MEMORY CARE AT PARADISE VILLAGEFACILITY NUMBER:
374603713
ADMINISTRATOR:MCGUIRK, BEVERLYFACILITY TYPE:
740
ADDRESS:735 ARCADIA AVENUETELEPHONE:
(619) 475-5040
CITY:NATIONAL CITYSTATE: CAZIP CODE:
91950
CAPACITY:70CENSUS: 48DATE:
11/02/2020
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
04:15 PM
MET WITH:Geovanni Aguilar, Associate DirectorTIME COMPLETED:
04:45 PM
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Licensing Program Analyst (LPA) Dawn Segura conducted a case management virtual visit, via video conference, to follow-up on an incident reported to Community Care Licensing. LPA virtually met with Geovanni Aguilar, Associate Director, during the video call.

Community Care Licensing received an SOC 341 on November 2, 2020, in which it was reported that Resident (R1) sustained an injury as a result of being hit by Resident 2 (R2) on October 30, 2020 [Associate Director was provided an LIC 811 Confidential Names List that identifies the resident].

During today's virtual visit, LPA interviewed the Associate Director, interviewed R1, and toured the facility. No deficiencies were cited during today’s visit.

A copy of this report and Licensee Appeal Rights (LIC 9058) were provided to Geovanni Aguilar via electronic mail. An electronic mail read receipt confirmation was requested to be sent to LPA upon receipt of the documents.
SUPERVISOR'S NAME: Rebecca HedgecockTELEPHONE: (619)767-2329
LICENSING EVALUATOR NAME: Dawn SeguraTELEPHONE: (619) 417-3928
LICENSING EVALUATOR SIGNATURE:

DATE: 11/02/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/02/2020
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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