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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306005798
Report Date: 10/29/2025
Date Signed: 10/29/2025 04:42:37 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 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
09/29/2025 and conducted by Evaluator Eboni Bentley
COMPLAINT CONTROL NUMBER: 22-AS-20250929104833
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: 150DATE:
10/29/2025
UNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Peggy Ulland, Executive DirectorTIME COMPLETED:
04:45 PM
ALLEGATION(S):
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Staff do not ensure call assistance buttons are responded to in a timely manner.
INVESTIGATION FINDINGS:
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On October 29, 2025, Licensing Program Analyst (LPA) Eboni Bentley arrived unannounced for the purpose of conducting a subsequent complaint investigation visit into the above allegation. LPA announced self and stated the purpose of the visit to staff. Executive Director (ED) Peggy Ulland shortly arrived on site to assist with the investigation. On October 6, 2025, LPA initiated the complaint investigation and toured the facility accompanied by ED Ulland and obtained documentation.
During the follow-up to the investigation, LPA was provided with Resident/staff roster, staff contacts, and staff schedule. The following documents were obtained for Resident 1 (R1): Admissions Agreement, staff schedule, Physician’s Report, Progress Notes, Bathing logs, Medication Administration Records, and Pendant/Call Logs. LPA requested additional hospital records, Home Health, Doctor’s orders, and any clinical records obtained for Resident be sent to the Department by 5pm on 10/29/2025.

CONTINUE TO LIC9099-D....
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Eboni Bentley
LICENSING EVALUATOR SIGNATURE:

DATE: 10/29/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/29/2025
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 5
Control Number 22-AS-20250929104833
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: PARK VIEW ESTATES
FACILITY NUMBER: 306005798
VISIT DATE: 10/29/2025
NARRATIVE
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The following was determined based on observations and record review:

Regarding the allegation that Staff do not ensure call assistance buttons are responded to in a timely manner, the following has been concluded: Based on record review of pendant button calls and responding time over a period of 90-days, it was established that there were approximately three occurrences of pendant button calls that were responded to between thirty-five minutes to one hour and eight minutes, calling the initial call. While some pendant button calls were addressed timely, these occurrences demonstrate that a timely response is not guaranteed. During an interview, Witness 1 (W1), reported waiting for 48 minutes to get a response when pendant button was used. W1 stated no one came so they went to get assistance from a caregiver in the hallway, outside of Resident 1 (R1’s) room.

Based on record review and observations made during the investigation, the preponderance of evidence standard has been met for allegation: Staff do not ensure call assistance buttons are responded to in a timely manner is deemed SUBSTANTIATED.

A deficiency is being cited as per the California Code of Regulations, Title 22, Division 6, Chapter 8. Civil Penalty Assessed.

An exit interview was conducted with Executive Director Peggy Ulland, and a copy of this report, LIC9099D, LIC421FC and appeal rights were provided at the end of the visit.
SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Eboni Bentley
LICENSING EVALUATOR SIGNATURE:

DATE: 10/29/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/29/2025
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 22-AS-20250929104833
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

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

FACILITY NAME: PARK VIEW ESTATES
FACILITY NUMBER: 306005798
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/29/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/05/2025
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 retrain staff regarding timely call button and pendant esponses 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 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.
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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: Lourdes Montoya
LICENSING EVALUATOR NAME: Eboni Bentley
LICENSING EVALUATOR SIGNATURE:

DATE: 10/29/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/29/2025
LIC9099 (FAS) - (06/04)
Page: 5 of 5