PARK VIEW ESTATES

Official classification

Type B

Official code

87465(c)(2)

Regulation authority

CCR

What the official deficiency says

87465 Incidental Medical and Dental Care (c) If the resident's physician has stated in writing that the resident ... provided all ... requirements are met: (2) Once ordered by the physician the medication is given according to the physician's directions. This requirement was not met as evidenced by: Based on observation, interviews, and record review, the facility did not administer medication to R1 as prescribed, which poses a potential Health, Safety, and Personal Rights risk to persons in care. Records reviewed indicate that the medication was administered to R1 on 9/21 & 9/23/2025, however progress notes state the medication was not available in the cart from 9/19-9/27/2025.

Official plan of correction

The facility will retrain all medication staff on the section cited above and submit proof of attendees to CCLD via email by POC due date.

Deadline recorded: Jun 11, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87211(a)(1)

Regulation authority

CCR

What the official deficiency says

87211 Reporting Requirements (a) Each licensee shall furnish to the licensing agency such reports as the Department may require... (1) A written report shall be submitted to the licensing agency and to the person responsible for the resident within seven days of the occurrence of any of the events... This requirement was not met as evidenced by: Based on observation, interviews, and record review, the facility did not administer medication to R1 as prescribed, which poses a potential Health, Safety, and Personal Rights risk to persons in care. Records reviewed corroborated that R1's medication errors were not reported within the required time frame.

Official plan of correction

Administrator stated that they will submit an incident report regarding R1's medication errors to the Department by COB on 6/8/2026. The facility will retrain all staff on the section cited above and submit proof of attendees to CCLD via email by POC due date.

Deadline recorded: Jun 11, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87609(a)(4)

Regulation authority

CCR

What the official deficiency says

87609 … Home Health Agencies ... (b) … (4) The licensee and home health agency agree in writing on the responsibilities … in caring for the resident’s medical condition(s). This requirement was not met as evidenced by: Based on interviews and documents, the licensee did not maintain home health agency agreements for R1 and R2 resulting in the facility not being able to confirm whether their suprapubic catheter needs were being met by home health, which poses a potential health risk to persons in care.

Official plan of correction

Licensee stated they will submit a protocol to LPA by POC due date for ensuring they have all required home health documentation for residents on home health.

Deadline recorded: Jun 8, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87613(a)(1)

Regulation authority

CCR

What the official deficiency says

87613 …Restricted Health Condition (a) … the licensee shall: (1) Communicate with all other persons who provide care to that resident …. This requirement was not met as evidenced by: Based on interviews and documents, the licensee did not communicate with R1’s doctor and home health regarding R1’s suprapubic catheter care needs resulting in R1 not receiving their full required catheter care for approximately three weeks, which poses a potential health risk to persons in care.

Official plan of correction

Licensee stated they will submit a protocol to LPA by POC due date for ensuring the facility is aware of residents’ home health care needs and is following up to ensure they are being met.

Deadline recorded: Jun 8, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87633(h)(4)

Regulation authority

CCR

What the official deficiency says

87633 Hospice Care… (h) … the licensee shall maintain … (4) A copy of the resident’s current hospice care plan approved by the licensee, the hospice agency, and the resident… This requirement was not met as evidenced by: Based on interviews and documents, the licensee did not maintain a copy of R2’s hospice care plan resulting in the facility not being able to confirm whether their suprapubic catheter needs were being met by hospice, which poses a potential health risk to persons in care.

Official plan of correction

Proposed POC: Licensee stated they will submit a protocol to LPA by POC due date for ensuring they have all required hospice documentation for residents on hospice.

Deadline recorded: Jun 8, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87208(a)

Regulation authority

CCR

What the official deficiency says

87208 Plan of Operation (a) … The plan and related materials shall be on file in the facility … This requirement was not met as evidenced by: Based on interviews, the licensee was unable to locate the plan of operation at the facility and had to obtain it from an off-site location, which poses a potential safety risk to persons in care.

Official plan of correction

Licensee showed LPA a printed copy of their plan of operation and confirmed a copy would be available at the facility moving forward. POC cleared.

Deadline recorded: Jun 8, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87303(a)

Regulation authority

CCR

What the official deficiency says

87303(a)The facility shall be clean, safe sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. This requirement is not met as evidenced by: Based on observation, interviews, and record review, the facility failed to comply with the section cited above in two out of two kitchen appliances, which poses a potential risk to persons in care. Interviews and record review revaled the dishwasher was leaking for at least one week and LPA observed a freezer in disrepair during the visit.

Official plan of correction

The administer stated the freezer will be repaired and will provide proof to CCLD by POC due date.

Deadline recorded: Mar 19, 2026. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87464(f)(1)

Regulation authority

CCR

What the official deficiency says

87464 Basic Services … (f) Basic services shall at a minimum include: (1) Care and supervision…This requirement was not met as evidenced by: Based on documents and interviews, the licensee did not provide the service of responding to R1's pendant call for assistance in a timely manner, three times within a 90 day period, which poses a potential personal rights risk to persons in care. Civil Penalty Assessed.

Official plan of correction

The licensee stated they will retrain staff regarding timely call button and pendant esponses and submit proof to LPA by POC due date.

Deadline recorded: Nov 5, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87464(f)(1)

Regulation authority

CCR

What the official deficiency says

87464 Basic Services … (f) Basic services shall at a minimum include: (1) Care and supervision…This requirement was not met as evidenced by: Based on documents and interviews, the licensee did not provide the service of having R1 eat in the assisted living dining room, which they prefer, six times a week as agreed and documented in R1’s care plan, which poses a potential personal rights risk to persons in care. Civil Penalty Assessed.

Official plan of correction

The licensee stated they will go back to the agreed upon schedule of R1 eating in the memory care dining room one day a week and submit proof to LPA by POC due date.

Deadline recorded: Oct 27, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87303(i)(1)(A)

Regulation authority

CCR

What the official deficiency says

87303 Maintenance and Operation … (i) Facilities shall have signal systems which shall meet the following criteria: (1) … (A) Operate from each resident's living unit... This requirement was not met as evidenced by: Based on observation, the licensee did not ensure memory care residents without pendants had access to a call system they could activate to request assistance or call for help in an emergency from their rooms, which poses an immediate safety risk to persons in care.

Official plan of correction

The licensee stated they will submit a plan to ensure all memory care residents have access to the call system from inside their rooms by POC due date. This is an amended report

Deadline recorded: Oct 20, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87224(a)

Regulation authority

CCR

What the official deficiency says

Eviction Procedures - The licensee may evict a resident for one or more of the reasons listed in Section 87224(a)(1) through (5). Thirty days written notice to the resident is required...This requirement was not met as evidenced by: Based on interviews and records review, the facility issued an eviction notice without complying with Title 22 regulations, including the requirement to provide information about available resources for the resident and the right to file a complaint with the Licensing Agency. This poses an immediate health, safety, and personal rights risk to residents in care.

Official plan of correction

Facility representative states, the eviction notice will be rescinded and notification will be emailed to R1's family, LPA Bentley, and LPA Haley. The plan of correction is due by 2:00pm on the POC due date.

Deadline recorded: Aug 22, 2025. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87464(f)(1)

Regulation authority

CCR

What the official deficiency says

878464 Basic Services: (f) Basic services shall at a minimum include: (1) Care and supervision as defined in Section 87101(c)(3) and Health and Safety Code section 1569.2(c). This requirement is not met as evidenced by: Based on LPA record review and interviews with residents and staff, pendant call times were not responded to in a timely manner. This poses and immediate health and safety risk to persons in care.

Official plan of correction

Facility will conduct an in-service training with staff regarding call pendant procedures. Executive Director (ED) Ulland will send proof of documentation to LPA by POC date via email with training provided and procedures implemented to address this issue.

Deadline recorded: May 21, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87468.2(a)(4)

Regulation authority

CCR

What the official deficiency says

Per CCR 87468.2(a)(4) on Additional Personal Rights of Residents in Privately Operated Facilities, residents are entitled: " To care, supervision, and services that meet their individual needs " . This requirement is not met as evidenced by: Based on the reviewed plan of care, the investigation evidenced insufficient catheter care provided to R1 by facility staff. This constitutes a potential risk to the health, safety and personal rights of individuals in care.

Official plan of correction

Adherence to R1's plan of care to be documented. Documentation to be provided to LPA before the plan of corrections due date.

Deadline recorded: May 30, 2025. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87303(a)

Regulation authority

CCR

What the official deficiency says

87303 Maintenance and Operation(a) The facility shall be... safe,... and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. This requirement was not met as evidenced by: Based on LPA's observations, interviews, and record review, the elevator is currently malfunctioning which poses a potential Health, Safety, or Personal Rights risk to persons in care.

Official plan of correction

Administrator stated that the elevator will be repaired and will notify LPA via email on or before the POC due date when the issue has been resolved.

Deadline recorded: Oct 4, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87303(b)

Regulation authority

CCR

What the official deficiency says

87303(b)-Maintenance and Operation : (b) A comfortable temperature for residents shall be maintained at all times. This requirement was not met as evidenced by: On or about 3:10pm while conducting interviews with residents in Activity room, LPA Quiroz observed temperature in activity room to be 80 degrees fahrenheit and observed temperature gage to be locked. At 3:20pm, Temperature was observed to increase to 82 degrees Fahrenheit, this was verified with Activity Director who indicated " Temperature is controlled from Marketing not here. " On or about 3:55pm, Maintenance Director CONT...

Official plan of correction

HWD agreed temperature in activity room is at a comfortable temperature prior to holding Activity and provide training on 87303 to all staff and submit proof of training by 4/25/2024. CONT... Matt Yem arrived to activity room to decrease room temperature. At 4:17pm, the temperature was recorded to be 78 degrees fahrenheit. Ten of ten interviewees indicated the activity room is always hot and not of comfortable temperature. This poses a potential risk to residents in care.

Deadline recorded: Apr 25, 2024. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

1569.625(a-e)

Regulation authority

HSC

What the official deficiency says

Staff training; legislative findings; contents. The department shall adopt regulations to require staff members...who assist residents with personal activities of daily living to receive appropriate training. This requirement is not met as evidenced by: based on interview and record review the licensee did not ensure staff received training pursuant to statute and regulation. This poses a potential risk to the health & safety of residents in care.

Official plan of correction

Licensee to ensure all staff are properly trained at all times pursuant to statute and regulation and submit proof of staff training to LPA by POC due date. Licensee to submit a written statement indicating how they intend to adhere to statute and regulation regarding staff training to LPA by POC due date.

Deadline recorded: Apr 14, 2023. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87755(b)

Regulation authority

CCR

What the official deficiency says

87755(b):Inspection Authority of the Licensing Agency(b) The licensee shall ensure that provisions are made for private interviews with any resident or any staff member;... facility. This requirement was not met as evidenced by: CONTINUED BELOW Baed on interview conducted with Luis Serrano, Chief Executive Officer (CEO). CEO Serrano approached LPAs Quiroz and Ramirez admitting to listening to private interview with Staff 1 (S1).

Official plan of correction

CEO Serrano and ED Jakini will review regulation 87755(b) and submit proof of understanding CCR 87755(b) by POC Due date of 12/16/2022. CEO and ED will ensure privacy while conducting interviews with residents or staff members and not retaliate to staff or residents. CONT BELOW... In the future, if interview conversations are overheard CEO and or/ED will notify LPA/LPAs.

Deadline recorded: Dec 16, 2022. A deadline is not proof that correction was completed.

Official classification

Type B

Official code

87211(a)(2)

Regulation authority

CCR

What the official deficiency says

87211(a)(2)Reporting Requirements:(a)Each licensee shall furnish to the licensing agency such reports...(2)Occurrences, such as epidemic outbreaks...shall be reported within 24 hours either by telephone or facsimile to the licensing agency and to the local health officer when appropriate. CONTINUED BELOW This requirement was not met as evidenced by: (ED) Fike indicated " Too much going on and it escaped me to report to CCLD. " This poses a potential risk for residents in care.

Official plan of correction

Executive Director and all staff assisting with reporting requirements will read CCR 87211 Reporting Requirements and submit proof of understanding CCR 87211 by POC due date of 9/23/2022.

Deadline recorded: Sep 23, 2022. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87464(f)(1)

Regulation authority

CCR

What the official deficiency says

Basic Services-87464(f)(1):Basic Services at a minimum shall include care and supervision. Care and supervision means the facility assumes responsibility for, or provides or promises to provide in the future, ongoing assistance with activities of daily living without which the resident’s physical health, mental health, safety CONTINED... or welfare would be endangered. This requirement was not met as evidenced by: On 1/12/22, Memory Care Director assessed (R1) for potential falls based on the fall assessment dated 12/10/21, and required fall monitoring. The facility staff failed to accurately assess and provide timely medical treatment for (R1). CONTINUED...

Official plan of correction

Licensee agrees to provide ongoing assistance to residents who need assistance with their activities of daily living. The assistance shall be provided to ensure that the residents physical health, mental health, safety and welfare are not endangered. This assistance will include providing more staff as needed to meet the needs of all residents.Certification will be provided by the Licensee as proof of understanding of this subsection by POC due date of 5/20/22. During duration period of 1/21/22-1/24/2022, (R1) resulted in three documented falls. While hospitalized at Fountain Valley Hospital, Dr. David Hamilton, MD diagnosed (R1) with fractured ribs from the fifth to the eight rib on the left side, weakness head injury and pneumonia.

Deadline recorded: May 18, 2022. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87705(c)(4)

Regulation authority

CCR

What the official deficiency says

Care of Persons with Dementia 87705(c)(4). There is an adequate number of direct care staff to support each resident’s physical…safety and health care needs as identified in his/her current appraisal This requirement was not met as evidenced by: Based on interviews, the facility failed to CONTINUED... ensure that facility staff follow protocol to support each resident’s physical, safety and health care needs as identified in current appraisal. The facility failed to have appropriate supervision to ensure that (R1) was observed and provided timely medical treatment after reported falls. Interviewees reported CONTINED...

Official plan of correction

Facility agrees to ensure that all staff follow protocols to meet and support the needs of the residents in care. ED agreed to instruct all staff to review each resident's care plan to ensure that all safety needs are met. ED will conduct in service training about Dementia care and safety to all facility staff. Proof of correction will be provided to CCLD by POC due date of 5/20/22. facility to be understaffed with little to no supervision on the weekends or evenings allowing for Caregivers and Medication Technicians to manage the facility. The facility failed to take preventative measures to decrease the risk for falls for (R1).

Deadline recorded: May 18, 2022. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87355(e)(2)

Regulation authority

CCR

What the official deficiency says

87355(e)(2) Criminal Record Clearance All individuals subject to a criminal record review pursuant to Health and Safety Code Section 1569.17(b) shall prior to working, residing or volunteering in a licensed facility: Request a transfer of a criminal record clearance as specified in Section 87355(c). CONTINUED BELOW... This requirement is not met as evidenced by: Based on records reviewed, the licensee failed to ensure S1’s criminal record clearance was transferred to the facility for associated. This poses an immediate safety risk to persons in care. AN IMMEDIATE CIVIL PENALTY OF $500 IS ASSESSED.

Official plan of correction

Administrator will sumbit proof of understanding CCR 87355(e)(2) and submit by COB 3/25/2022.

Deadline recorded: Mar 22, 2022. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87465(a)(2)

Regulation authority

CCR

What the official deficiency says

87465(a)(2) Incidental Medical and Dental Care:The licensee shall provide assistance in meeting necessary medical and dental needs. This includes transportation which may be limited to the nearest available medical or dental facility which will meet the resident's need. This requirement is not met as evidence by: CONTINUE BELOW... Based on video reviewed, the licensee failed to meet medical needs of residents after failing to seek medical attention after R1 was observed continuously yelling in pain while being assisted by S1. R1 was transported to the hospital via their responsible party two days later. CONTINUED NEXT SECTION...

Official plan of correction

Administrator will sumbit proof of understanding CCR 87465(a)(2) and provide training to all level of care staff and submit proof of training by COB 3/25/2022. This poses an immediate health risk to the resident in care.

Deadline recorded: Mar 22, 2022. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87412(a)

Regulation authority

CCR

What the official deficiency says

87412(a) Personnel Records:The licensee shall ensure that personnel records are maintained on the licensee, administrator and each employee. Each personnel record shall contain the following information...This requirement is not met as evidence by: CONTINUED BELOW Based on interviews conducted, the licensee failed to ensure S1’s personnel records were retained on site. This poses a potential safety risk to persons in care.

Official plan of correction

Administrator agreed to read and understand CCR 87412(a) and submit proof of understanding by COB 3/25/2022.

Deadline recorded: Mar 22, 2022. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87468.1(a)(1)

Regulation authority

CCR

What the official deficiency says

87468.1 (a)(1) (Personal Rights of Residents in All Facilities) (a)Residents in all residential care facilities for the elderly shall have all of the following personal rights:(1)To be accorded dignity in their personal relationships with staff, residents, and other persons.CONT BELOW... This requirement is not met as evidenced by: Based on videos reviewed and interviews conducted, the licensee failed to ensure R1’s personal right were not violated as on 9/30/21, S1 was observed yanking on R1’s extremities and shoulder while assisting with ADLs. CONTINUED NEXT SECTION...

Official plan of correction

Administrator will provide CCR 87468.1(a)(1) (Personal Rights of Residents in all facilities) training to all staff and submit proof of training by 3/25/2022. Despite R1’s repeated yelling in pain and calls for help, S1 continued to pull, shove and manipulate R1’s body in an effort to force R1 out of bed resulting in a diagnosed pelvic fracture. This poses an immediate health, safety and personal rights risk to persons in care.

Deadline recorded: Mar 25, 2022. A deadline is not proof that correction was completed.

Official classification

Type A

Official code

87303(e)(2)

Regulation authority

CCR

What the official deficiency says

873039E)(2) Maintenance and Operation. Water supplies and plumbling fixtures shall be maintained as follows: Faucets used by residents for personal care such as shaving and grooming shall deliver hot water. Hot water temperature controls shall be maintained to automatically regulate the temperature of hot water used by residents to attain a temperature of not less than 105 degree F (41 degree C) and not more than 120 degree F (49 degree C). Deficient Practice Statement Based on observation and interview, the licensee did not comply with the section cited above in 10 out of 10 resident rooms which poses an immediate health, safety or personal rights risk to persons in care. The hot water measured ranged from 125.2 degrees Fahrenheit to 138.0 degrees Fahrenheit which was verified by HSD Mariona.

Official plan of correction

POC Due Date: 02/22/2022 Plan of Correction Licensee to ensure the hot water temperatiure is maintained pursuant to regulation and submit written proof to LPA Velazquez by POC due date.