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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306005798
Report Date: 10/06/2025
Date Signed: 05/18/2026 02:56:48 PM

Unsubstantiated


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
08/29/2025 and conducted by Evaluator Sean Haddad
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20250829102755
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: 148DATE:
10/06/2025
UNANNOUNCEDTIME BEGAN:
07:57 AM
MET WITH:Peggy UllandTIME COMPLETED:
09:00 AM
ALLEGATION(S):
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9
Staff retaliated against resident in care
INVESTIGATION FINDINGS:
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2
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13
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 staff retaliated against resident in care revealed the following: During the course of the investigation, LPA inspected the facility, interviewed AD, witnesses, and staff, and obtained and reviewed copies of the resident roster, staff roster, Resident #1’s (R1) Admission Agreement, and R1’s Medical Records.

Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Sean Haddad
LICENSING EVALUATOR SIGNATURE:

DATE: 05/18/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/18/2026
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-20250829102755
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: 10/06/2025
NARRATIVE
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It was alleged that the facility retaliated against R1 by adding additional unnecessary and non-medical care for R1, which was duplicative of the care provided by the facility’s staff and charged R1’s responsible party without their approval.

The investigation revealed that R1 was admitted to the facility with a foley catheter and subsequently had surgery to replace insertion of the foley catheter with a suprapubic catheter. R1’s Medical Records document that R1 needed daily cleaning and bandage changes for their suprapubic catheter, which must be performed by a skilled professional. However, R1’s Home Health Records and interviews revealed that this skilled care was provided approximately twice a week. The facility advised R1 that their needs were not being met, they needed a higher level of care, and that one-on-one supervision would be required. R1’s family believes the requirement of one-on-one supervision was retaliation due to issues they had raised with the facility. However, the facility’s policy and R1’s Admission Agreement indicate temporary one-on-one supervision would be instituted at the resident’s expense when it has been determined that a resident needs a higher level of care. The facility retained an outside agency to provide one-on-one supervision to R1, but the service was never provided as R1’s family refused and obtained their own private caregiver.

Based on gathered information, R1 requires a higher level of care, due to their suprapubic catheter which required daily cleaning, bandage changes and frequent showers. In addition, R1 required additional supervision to prevent R1 from picking at their catheter site, which was observed to be red and irritated. There is no evidence to support that these care requirements were imposed in retaliation.

Based on LPA’s observation, interviews conducted, and records reviewed, there was not sufficient evidence to support the above allegations. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are deemed UNSUBSTANTIATED.

An exit interview was conducted, and a copy of this report was discussed with and provided to facility representative.

This is an amended report.
SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Sean Haddad
LICENSING EVALUATOR SIGNATURE:

DATE: 05/18/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/18/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 22-AS-20250829102755
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: 10/06/2025
NARRATIVE
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3
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This is an amended report.
SUPERVISORS NAME: Lourdes Montoya
LICENSING EVALUATOR NAME: Sean Haddad
LICENSING EVALUATOR SIGNATURE:

DATE: 05/18/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/18/2026
LIC9099 (FAS) - (06/04)
Page: 3 of 5
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
08/29/2025 and conducted by Evaluator Sean Haddad
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20250829102755

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: 148DATE:
10/06/2025
UNANNOUNCEDTIME BEGAN:
07:57 AM
MET WITH:Peggy UllandTIME COMPLETED:
09:00 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Resident's change of condition was not brought to the attention of the resident's physician and the resident's responsible person
INVESTIGATION FINDINGS:
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3
4
5
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7
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13
This unannounced inspection is being conducted by Licensing Program Analysts (LPAs) Eboni Bentley and Sean Haddad for the purpose of delivering findings for the investigation into the above identified complaint allegation. LPAs met with Administrator (AD) Peggy Ulland and explained the reason for today’s inspection.

The investigation into the allegation that resident's change of condition was not brought to the attention of the resident's physician and the resident's responsible person revealed the following: During the course of the investigation, LPAs inspected the facility, interviewed AD, witnesses, and staff, and obtained and reviewed copies of the resident roster, staff roster, and Resident #1’s (R1) Medical Records dated August 8, 2025.

CONTINUED
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Sean Haddad
LICENSING EVALUATOR SIGNATURE:

DATE: 10/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/06/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 22-AS-20250829102755
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: 10/06/2025
NARRATIVE
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It was alleged that on August 8, 2025, R1 was observed to have a blood-stained catheter bandage, but that staff did not notice the stain or report it to R1’s doctor or responsible party, R1 was taken to the hospital, the hospital determined no additional treatment and R1 was able to return to the facility with no special care or changes in medication required. Per R1’s family, on August 4, 2025, R1 had surgery to replace a foley catheter with a suprapubic catheter. R1’s family stated that on August 8, 2025, R1 was observed with a blood-stained catheter bandage, which was not noticed or reported by staff. When interviewed, AD stated that the blood observed was only a small amount and was to be expected after surgery, paramedics arrived and agreed with AD’s assessment, but R1’s family insisted on taking R1 to the ER and R1 returned a few hours later. However, R1’s family stated it was actually AD who thought the blood was a major issue and wanted to send R1 to the hospital, R1’s family did not have concerns about the blood stain, and R1 returned from the hospital with no concerns or changes of condition noted by the doctor. R1’s Medical Records dated August 8, 2025, corroborate that R1 was seen at the ER, no treatment was needed, and there was no change in condition. No information was obtained corroborating that R1 had a change of condition or that the blood stain noted on R1’s bandages was unexpected after R1’s surgery.

The Department has investigated the above allegation and found it to be Unfounded, meaning the allegation was false, could not have happened, or is without reasonable basis. An exit interview was conducted and a copy of this report was discussed with and provided to facility representative.
SUPERVISORS NAME: Armando J Lucero
LICENSING EVALUATOR NAME: Sean Haddad
LICENSING EVALUATOR SIGNATURE:

DATE: 10/06/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

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