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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374603713
Report Date: 08/29/2024
Date Signed: 08/29/2024 11:22:18 AM


Document Has Been Signed on 08/29/2024 11:22 AM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SO. CAL AC/SC, 7575 METROPOLITAN DR. #109
SAN DIEGO, CA 92108



FACILITY NAME:PARKVIEW MEMORY CARE AT PARADISE VILLAGEFACILITY NUMBER:
374603713
ADMINISTRATOR:AGUILAR, GEOVANNIFACILITY TYPE:
740
ADDRESS:735 ARCADIA AVENUETELEPHONE:
(619) 475-5040
CITY:NATIONAL CITYSTATE: CAZIP CODE:
91950
CAPACITY:70CENSUS: 48DATE:
08/29/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Administrator Geovanni AguilarTIME COMPLETED:
11:00 AM
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
Licensing Program Analyst (LPA) Alyssa Ramirez conducted an unannounced Case Management - Incident visit. LPA was welcomed by, identified herself to, and discussed the purpose of the visit with Health Services Director Alyssa Ukaj. Administrator Geovanni Aguilar later arrived to meet with LPA.

Today's visit was in response to an LIC624 Incident Report, which licensee self-submitted to the CCLD San Diego Regional Office. According to the LIC624: on 7/10/24, Resident #1 (R1) eloped from the facility (left without staff supervision). [See LIC 811 Confidential Names List for a description of R1.] R1 was located on facility grounds.

During today’s visit, LPA performed a facility tour / welfare check, collected records, and interviewed staff and client.

According to R1’s latest LIC602 Physician’s Report their doctor determined that R1 is unable to safely leave the facility unassisted. Interviews and records showed that Licensee had a written Absentee Notification Plan as part of R1’s record of care, and that staff followed this plan.

No deficiencies were cited for this incident. No deficiencies were observed or cited during today's visit.

An exit interview was conducted with Aguilar, to whom a copy of this report, the LIC811 Confidential Names List, and the Licensee/Appeal Rights (LIC9058 03/22) were provided during the visit.
SUPERVISOR'S NAME: Simon JacobTELEPHONE: (619) 767-2306
LICENSING EVALUATOR NAME: Alyssa RamirezTELEPHONE: 619-767-2301
LICENSING EVALUATOR SIGNATURE:
DATE: 08/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/29/2024
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