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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306005798
Report Date: 10/13/2025
Date Signed: 10/13/2025 04:24:06 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/19/2025 and conducted by Evaluator Sean Haddad
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20250919161621
FACILITY NAME:PARK VIEW ESTATESFACILITY NUMBER:
306005798
ADMINISTRATOR:MARIA ARRIAGAFACILITY TYPE:
740
ADDRESS:11360 WARNER AVE.TELEPHONE:
(949) 333-3486
CITY:FOUNTAIN VALLEYSTATE: CAZIP CODE:
92708
CAPACITY:170CENSUS: 153DATE:
10/13/2025
UNANNOUNCEDTIME BEGAN:
10:51 AM
MET WITH:Peggy UllandTIME COMPLETED:
04:38 PM
ALLEGATION(S):
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Facility did not allow resident access to dining room.
INVESTIGATION FINDINGS:
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This unannounced inspection is being conducted by Licensing Program Analyst (LPA) Sean Haddad for the purpose of delivering findings for the investigation into the above identified complaint allegation. LPA met with Administrator (AD) Peggy Ulland and explained the reason for today’s inspection.
The investigation into the allegation that facility did not allow resident access to dining room revealed the following: During the course of the investigation, LPAs inspected the facility, interviewed AD, residents, witnesses, and staff, and obtained and reviewed copies of the resident roster, staff roster, Resident #1’s (R1) Medical Records dated October 30, 2024, R1’s Physician’s Report dated September 13, 2024, R1’s Admission Agreement, R1’s Service Plan dated September 3, 2025, and R1’s Progress Notes.

It was alleged that R1, who lives in the memory care section and has always eaten in the assisted living dining room per agreement with the facility, is no longer allowed to eat in the assisted living dining room. Per R1’s Medical Records dated October 30, 2024, R1 has mild dementia and R1’s Physician’s Report dated September 13, 2024, indicates R1 has mild cognitive impairment and is non-ambulatory.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Sean Haddad
LICENSING EVALUATOR SIGNATURE:

DATE: 10/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/13/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 7
Control Number 22-AS-20250919161621
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: PARK VIEW ESTATES
FACILITY NUMBER: 306005798
VISIT DATE: 10/13/2025
NARRATIVE
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Per R1’s family, R1 is eligible for assisted living based on their cognitive status but was placed in memory care because facility staff advised that R1’s physical needs could be better met in memory care and because there was an available room in memory care. R1’s family stated they agreed to this arrangement as long as R1 had access to all of the assisted living amenities, including the dining room. When interviewed, R1 also stated that eating in the assisted living dining room was a condition of their admission to the facility. R1’s Admission Agreement does not indicate whether R1 lives in assisted living or memory care and does not mention any agreement that R1 be allowed to eat in a particular dining room. However, R1’s Service Plan dated September 3, 2025, states that caregivers will escort R1 to the assisted living dining room for all meals and that this has been part of R1’s care plan since R1 was admitted, which shows that there was an agreement that R1 would live in memory care but eat in assisted living. No information was obtained regarding whether or not this was to be a temporary agreement, but the facility complied with the agreement for approximately one year.
When interviewed, AD stated that when R1 moved in, R1 was allowed to eat in the assisted living dining room to help them acclimate to the facility, but the agreed upon plan was always to transition R1 to eat in the memory care dining room. Per AD, in early September 2025, R1 began to transition to eating in the memory care dining room starting with once a week and increasing in frequency until they ate only in the memory care dining room, R1 and their family agreed to this, and R1 has been enjoying eating in the memory care dining room and is making friends there, although sometimes R1 forgets that the transition is going on and believes they should be eating in the assisted living dining room. Per R1’s Progress Notes, on September 3, 2025, it was noted that R1 will transition to having meals in the memory care dining room starting September 8, 2025, and R1’s family was present during this conversation with R1. Per R1’s family, on August 26, 2025, a meeting was held where facility staff advised R1’s family that they believed R1 needed to live fully in memory care, which R1’s family disputed. However, it was agreed that R1 would eat in the memory care dining room one day per week. AD stated that R1 and their family agreed to start having R1 eat in the memory care dining room once per week but that the number of days per week would gradually increase until R1 ate only in the memory care dining room. However, R1’s family denied ever agreeing to have R1 eat in the memory care dining room more than once per week. R1’s Progress Notes indicate that on September 16, 2025, R1 was upset when told to have dinner in the memory care dining room, refused to go and returned to their room, and did not eat much of dinner and per R1’s family, R1 contacts them complaining about not being allowed to eat in assisted living. However, per AD and R1’s Progress Notes, R1 has communicated that they enjoy eating in the memory care dining room multiple times and any instances of R1 complaining about eating in the memory care dining room are the result of R1 being coached to say these things.
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Sean Haddad
LICENSING EVALUATOR SIGNATURE:

DATE: 10/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/13/2025
LIC9099 (FAS) - (06/04)
Page: 2 of 7
Control Number 22-AS-20250919161621
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: PARK VIEW ESTATES
FACILITY NUMBER: 306005798
VISIT DATE: 10/13/2025
NARRATIVE
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Per an email from R1’s family dated September 23, 2025, R1’s family confirmed to the facility that the agreement was only that R1 would eat in the memory care dining room once per week and would have all other meals in the assisted living dining room. When interviewed, R1 denied agreeing to eat in the memory care dining room, stated they want to eat in the assisted living dining room, and specifically described what aspects of the memory care dining room they do not like. Based on the information obtained, R1 and their family did not agree to have R1 eat in the memory care dining room more than once per week. However, per R1’s Progress Notes, as of September 15, 2025, R1 was eating in the memory care dining room twice a week and per AD, as of October 6, 2025, R1 is eating in the memory care dining room four times a week. AD stated that the facility offered R1’s family to reassess R1 for suitability in assisted living so R1 could move to assisted living, but R1’s family refused. However, the facility also did not conduct a reassessment showing a change of condition requiring R1 to fully live in the memory care unit without access to assisted living amenities as previously agreed and documented in R1’s care plan, although AD stated they brought this up to R1’s family multiple times.

Based on the information obtained, there was an agreement to have R1 eat in the assisted living dining room at least six days a week, this service was documented in R1’s care plan, and the facility stopped providing this service without agreement from R1 and their family or properly reassessing R1 to document why R1 should fully live in memory care without access to assisted living amenities. While R1 may have enjoyed eating in memory care in some instances, R1 also communicated their preference to eat in assisted living in other instances. The information obtained corroborated the allegation.

During the course of the investigation, the Department obtained sufficient evidence to substantiate the allegation mentioned above. The preponderance of evidence standard has been met; therefore, the above allegation is Substantiated. See LIC9099D for cited deficiencies per Title 22 Division 6 of the California Code of Regulations. Civil penalties for repeat violations are being assessed. See LIC421FC. An exit interview was conducted and a copy of this report and appeal rights was discussed with and provided to facility representative.
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Sean Haddad
LICENSING EVALUATOR SIGNATURE:

DATE: 10/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/13/2025
LIC9099 (FAS) - (06/04)
Page: 3 of 7
Control Number 22-AS-20250919161621
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: PARK VIEW ESTATES
FACILITY NUMBER: 306005798
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/13/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Request Denied
Type B
10/27/2025
Section Cited
CCR
87464(f)(1)
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87464 Basic Services … (f) Basic services shall at a minimum include: (1) Care and supervision…This requirement was not met as evidenced by:
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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.
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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.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Sean Haddad
LICENSING EVALUATOR SIGNATURE:

DATE: 10/13/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/13/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 7
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
This is an official report of an unannounced visit/investigation of a complaint received in our office on
09/19/2025 and conducted by Evaluator Sean Haddad
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20250919161621

FACILITY NAME:PARK VIEW ESTATESFACILITY NUMBER:
306005798
ADMINISTRATOR:MARIA ARRIAGAFACILITY TYPE:
740
ADDRESS:11360 WARNER AVE.TELEPHONE:
(949) 333-3486
CITY:FOUNTAIN VALLEYSTATE: CAZIP CODE:
92708
CAPACITY:170CENSUS: 153DATE:
10/13/2025
UNANNOUNCEDTIME BEGAN:
10:51 AM
MET WITH:Peggy UllandTIME COMPLETED:
04:38 PM
ALLEGATION(S):
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Facility call system does not operate from residents' rooms.
INVESTIGATION FINDINGS:
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 This is an amended report

This unannounced inspection is being conducted by Licensing Program Analyst (LPA) Sean Haddad for the purpose of delivering findings for the investigation into the above identified complaint allegation. LPA met with Administrator (AD) Peggy Ulland and explained the reason for today’s inspection.

The investigation into the allegation that facility call system does not operate from residents' rooms revealed the following: During the course of the investigation, LPAs inspected the facility, interviewed AD, residents, witnesses, and staff, and obtained and reviewed copies of the resident roster and staff roster.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Sean Haddad
LICENSING EVALUATOR SIGNATURE:

DATE: 12/30/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/30/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 5 of 7
Control Number 22-AS-20250919161621
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: PARK VIEW ESTATES
FACILITY NUMBER: 306005798
VISIT DATE: 10/13/2025
NARRATIVE
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It was alleged that the facility’s memory care call system does not meet Title 22 requirements and is ineffective because it uses motion detectors that cannot be activated by residents to call for help and the facility’s pendants are voluntary and most memory care residents do not have them. When interviewed, AD confirmed that the only aspect of the facility’s call system inside memory care rooms is a motion detector system. LPA inspected the facility and observed that, while assisted living rooms have call buttons, memory care rooms have only motion detectors, although there are call buttons on the outside of the memory care rooms near the front doors. LPA interviewed the facility’s maintenance director who stated the motion detectors in the memory care bedrooms and bathrooms register movement and trigger an alert if there is a certain level of continuous movement which directs care staff to check on residents in their rooms in addition to their regular checks. Per the facility’s maintenance director, the motion detector system also registers residents’ open doors. However, neither of these functions meet the purpose of a call system, which is to allow a resident to call for assistance when needed or for help during an emergency. Per AD, seven out of the 42 residents in memory care have pendants, which allows these residents to call for help, which means 35 residents in memory care have no access to a call system. LPA interviewed five memory care residents, three of whom did not have pendants and confirmed that the only way to request assistance is to leave their rooms and go find staff physically. In addition, when LPA tested the motion detectors in five memory care rooms by triggering them repeatedly to test whether they would trigger any alert, the motion detector system malfunctioned and became non-functional for multiple hours, while the pendant system still operated properly. LPA also noted that the detector near the beds would not register someone in bed waving their arms around and, even if it did, it is unclear if the detector would activate any alert or simply log the motion. The information obtained corroborated the allegation, as not only did the motion detector system malfunction when tested, it cannot meet the requirements of a call system for memory care residents even when operating as designed.

During the course of the investigation, the Department obtained sufficient evidence to substantiate the allegation mentioned above. The preponderance of evidence standard has been met; therefore, the above allegation is Substantiated. See LIC9099D for cited deficiencies per Title 22 Division 6 of the California Code of Regulations. An exit interview was conducted and a copy of this report and appeal rights was discussed with and provided to facility representative.

This is an amended report
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Sean Haddad
LICENSING EVALUATOR SIGNATURE:

DATE: 12/30/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/30/2025
LIC9099 (FAS) - (06/04)
Page: 6 of 7
Control Number 22-AS-20250919161621
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868

FACILITY NAME: PARK VIEW ESTATES
FACILITY NUMBER: 306005798
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/13/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
10/20/2025
Section Cited
CCR
87303(i)(1)(A)
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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:
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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.
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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.
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This is an amended report
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Sean Haddad
LICENSING EVALUATOR SIGNATURE:

DATE: 12/30/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/30/2025
LIC9099 (FAS) - (06/04)
Page: 7 of 7