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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 374603713
Report Date: 06/23/2021
Date Signed: 06/23/2021 02:27:00 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:LAWSON, WILLIAMFACILITY TYPE:
740
ADDRESS:735 ARCADIA AVENUETELEPHONE:
(619) 475-5040
CITY:NATIONAL CITYSTATE: CAZIP CODE:
91950
CAPACITY:70CENSUS: 46DATE:
06/23/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Administrator, Geovanni AguilarTIME COMPLETED:
01:25 PM
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 Manager (LPM) John Rante and Licensing Program Analyst (LPA) Marisela Garcia-Centeno conducted unannounced Case Management. LPM and LPA identified themselves to the Administrator, Geovanni Aguilar, and we discussed the purpose of the visit.

Today's visit is in response to the AWOL of Resident 1 (R1 - see LIC811 Confidential Names List), date of incident: June 19, 2021. The facility properly reported R1 missing to local law enforcement, R1's family, and to CCLD, timely. The facility's Missing Persons Notification Plan was reviewed on this date with the Licensee. R1 was returned safely to the facility by staff within an hour of AWOL. LPA conducted interviews with R1 on this date, and they presented with no signs of injury, and follow up has already been scheduled with their PCP. In addition, facility staff installed additional safety metal plates to all exit doors on both floors to prevent residents/staff to tamper with locking mechanism. As an extra safety measure additional sounding alarms were installed as well on the inner exit door and the outer exit doors. These doors were tested by the LPA, and were operating as intended.

No deficiencies were cited or observed on this date.

An exit interview was conducted with the Administrator. A copy of this report along with Licensee/Appeal Rights (LIC9058 01/16) was provided to Aguilar via email with an electronic read receipt.
SUPERVISOR'S NAME: John RanteTELEPHONE: (619) 994-7269
LICENSING EVALUATOR NAME: Marisela Garcia-CentenoTELEPHONE: (619) 323-4834
LICENSING EVALUATOR SIGNATURE:

DATE: 06/23/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/23/2021
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