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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306005798
Report Date: 06/04/2026
Date Signed: 06/04/2026 05:43:25 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: 143DATE:
06/04/2026
UNANNOUNCEDTIME BEGAN:
08:00 AM
MET WITH:Peggy Ulland - Executive DirectorTIME COMPLETED:
03:00 PM
ALLEGATION(S):
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Staff do not ensure residents medications are being properly managed.
INVESTIGATION FINDINGS:
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On June 4,2026, 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. LPA met with Executive Director (ED) Peggy Ulland and delivered findings.

During the visit, LPA reviewed Resident/staff roster, staff contacts, staff schedule, staff schedule, Physician’s Report. The following documents were obtained for Resident R1: Face Sheet, Physician’s report, Pre-appraisal, Needs and Service Plan, Progress Notes, Admissions Agreement, Bathing Schedule logs, Medication Administration Records, and Pendant/Call Logs, Hospital Records, Home Health Records, Doctor’s orders, and Pharmacy Records.

CONTINUE TO LIC9099-C....
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kevin Saborit-Guasch
LICENSING EVALUATOR NAME: Eboni Bentley
LICENSING EVALUATOR SIGNATURE:

DATE: 06/04/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/04/2026
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-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: 06/04/2026
NARRATIVE
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Regarding the allegation, Staff do not ensure residents medications are being properly managed, it was alleged that facility staff did not administer medication as prescribed. Based on record review, Yorba Linda Pharmacy received an order for R1 on September 17, 2025 from Dr. Muhammad. The order for Levofloxacin was filled and delivered to the facility on September 19, 2025. According to facility staff, when a medication is delivered to the facility and pending, it is physically placed with the Centrally Stored Medication. Prior to administration, a nurse reviews and approves the medication, and places it in the medication cart. When approved, the medication populates on the MARs and Med Techs are able to begin administering the medication to the resident. Facility progress notes indicate that on September 19, 2025 at 21:25, the medication was administered to R1 “at 9pm per Wellness Nurse”, however this is not reflected on the Medication Administration Records (MARs). On September 20, 2025 at 10:03, a progress note states the medication is not available. On September 21, September 23, and September 27, 2025, progress notes state the medication is not located in the med cart and staff will follow up with the pharmacy. Per the MAR, on September 21 and September 23, 2025, the medication was administered to R1 and signed by Med Techs. These errors were not reported to the Department as of June 4, 2026.

Based on record review and observations made during the investigation, the preponderance of evidence standard has been met for allegation: Staff do not ensure residents medications are being properly managed is deemed SUBSTANTIATED.

An exit interview was conducted with Executive Director Peggy Ulland, and a copy of this report, LIC9099D, LIC811, and appeal rights were provided at the end of the visit.
SUPERVISORS NAME: Kevin Saborit-Guasch
LICENSING EVALUATOR NAME: Eboni Bentley
LICENSING EVALUATOR SIGNATURE:

DATE: 06/04/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/04/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 5
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: 143DATE:
06/04/2026
UNANNOUNCEDTIME BEGAN:
08:00 AM
MET WITH:Peggy Ulland - Executive DirectorTIME COMPLETED:
03:00 PM
ALLEGATION(S):
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Facility is charging resident for service that are not being provided.
INVESTIGATION FINDINGS:
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The following was determined during the course of the investigation:

Regarding the allegation, Facility is charging resident for services that are not being provided, it was alleged that R1 is paying for bathing/shower assistance for four days per week but was only being provided assistance for one shower per week. LPA interviewed Witness #1 (W1) who stated that on one occasion they noticed that R1 had body odor and their nails were dirty. W1 stated they raised this concern to the facility, and R1’s showers were increased. The facility’s Health Services Director at the time, stated R1 repeatedly refused showers when caregivers attempted to assist. Five out of five caregivers corroborated this statement and denied the allegation. One staff member stated caregivers would try to initiate shower assistance, however R1 would often refuse, staff would return later to make a second and third attempt but R1 would continue to refuse assistance.

CONTINUE TO LIC9099-C....
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Kevin Saborit-Guasch
LICENSING EVALUATOR NAME: Eboni Bentley
LICENSING EVALUATOR SIGNATURE:

DATE: 06/04/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/04/2026
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 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: 06/04/2026
NARRATIVE
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LPA attempted to interview R1, however the resident no longer resides at the facility. Seven out of nine residents interviewed reported having no issues with receiving the services they are being charged for, with four of those residents adding they get all the shower assistance they need, as scheduled. A review of R1’s service plan dated September 10, 2025, indicates R1 needed assistance with showers, which were scheduled for three days per week. LPA reviewed the facility’s shower logs from that period which confirm R1 refused showers at least six days during the three months they resided at the facility.

Based on the information gathered during the investigation and review of all documents obtained, the Department is unable to ascertain if the above allegation occurred as reported. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove or refute the alleged violation occurred; therefore, the allegation is deemed Unsubstantiated.

An exit interview was conducted with Executive Director Peggy Ulland, and a copy of this report provided at the end of the visit.
SUPERVISORS NAME: Kevin Saborit-Guasch
LICENSING EVALUATOR NAME: Eboni Bentley
LICENSING EVALUATOR SIGNATURE:

DATE: 06/04/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/04/2026
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: 06/04/2026
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/11/2026
Section Cited
CCR
87465(c)(2)
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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:
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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.
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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.
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Type B
06/11/2026
Section Cited
CCR
87211(a)(1)
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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:
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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.
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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.
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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: Kevin Saborit-Guasch
LICENSING EVALUATOR NAME: Eboni Bentley
LICENSING EVALUATOR SIGNATURE:

DATE: 06/04/2026
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/04/2026
LIC9099 (FAS) - (06/04)
Page: 5 of 5