Inspection Reports for Park View Estates Assisted Living & Memory Care
11360 Warner Ave, Fountain Valley, CA 92708, United States, CA, 92708
Back to Facility ProfileInspection Report Summary
Most inspections found no deficiencies, and several complaint investigations were unsubstantiated, indicating generally good compliance. The most recent report from October 29, 2025, did not cite any deficiencies but noted that further investigation is required related to ongoing complaints. Past issues included delayed response times to resident call pendants posing immediate health risks in May 2025 and insufficient catheter care for one resident, both substantiated with deficiencies cited. Other isolated deficiencies involved missing staffing records due to software changes, staff training gaps, and a prior elevator malfunction that was later resolved. The facility’s record shows some improvement over time, with recent inspections mostly clear of deficiencies and many complaints found unsubstantiated.
Deficiencies (last 4 years)
Deficiencies (over 4 years)
3.8 deficiencies/year
Deficiencies are regulatory violations found during state inspections.
5% better than California average
California average: 4 deficiencies/yearDeficiencies per year
4
3
2
1
0
Census
Latest occupancy rate
88% occupied
Based on a October 2025 inspection.
This facility has shown a steady increase in demand based on occupancy rates.
Census over time
Inspection Report
Census: 150
Capacity: 170
Deficiencies: 0
Oct 29, 2025
Visit Reason
This unannounced Case Management – Other inspection was conducted for the purpose of additional investigation related to two complaint control numbers: 22-AS-20250829102755 and 22-AS-20250919161621.
Findings
During the inspection, the Licensing Program Analyst interviewed the administrator and staff, and reviewed resident records. The facility representative was advised that further investigation is required at this time.
Complaint Details
Inspection was triggered by complaints under control numbers 22-AS-20250829102755 and 22-AS-20250919161621. Further investigation is required.
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Sean Haddad | Licensing Program Analyst | Conducted the inspection and investigation. |
| Peggy Ulland | Administrator | Met with Licensing Program Analyst during inspection. |
| Maria Arriaga | Administrator/Director | Named as facility administrator/director. |
Inspection Report
Complaint Investigation
Census: 150
Capacity: 170
Deficiencies: 0
Oct 27, 2025
Visit Reason
The visit was an unannounced Case Management visit to amend a previously issued complaint report under complaint number #22-AS-20220131170149.
Findings
The amended complaint report was reviewed and signed by the Executive Director along with the Case Management report. No new deficiencies or findings are detailed in this report.
Complaint Details
The visit was related to amending a previously issued complaint report under complaint number #22-AS-20220131170149.
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Samer Haddadin | Licensing Program Analyst | Conducted the unannounced Case Management visit. |
| Peggy Ulland | Executive Director | Met with Licensing Program Analyst during the visit and signed the amended complaint report. |
| Maria Arriaga | Administrator/Director | Named as facility administrator/director. |
Inspection Report
Complaint Investigation
Census: 152
Capacity: 170
Deficiencies: 0
Aug 19, 2025
Visit Reason
The inspection was an unannounced complaint investigation visit triggered by an allegation that staff represented themselves as the resident to authorize the bank to issue a check to the facility.
Findings
The investigation included interviews, a tour of the facility, and document reviews. The allegation was found to be unsubstantiated due to insufficient evidence to prove or refute the claim.
Complaint Details
The complaint alleged that staff represented themselves as the resident to authorize the bank to issue a check to the facility. The allegation was unsubstantiated after investigation.
Report Facts
Due balance: 42774.41
Checks issued: 2
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Celine Rodriguez | Licensing Program Analyst | Conducted the complaint investigation and authored the report |
| Hanofi Edogiawerie | Health and Wellness Director | Met with the investigator and participated in the exit interview |
| Sheila Santos | Licensing Program Manager | Named in the report as Licensing Program Manager |
Inspection Report
Monitoring
Census: 150
Capacity: 170
Deficiencies: 0
Jul 3, 2025
Visit Reason
An unannounced case management visit was conducted to monitor compliance assurance following a Non-Compliance Conference held on 2025-05-28.
Findings
The facility was found to be in compliance with all reviewed areas from the Non-Compliance Conference plan agreement. No health or safety issues were observed, staff training and audits were in order, and all records were within agreed conditions. No deficiencies were cited during this inspection.
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Peggy Ulland | Executive Director | Met during the inspection and participated in the exit interview. |
| Tina Tanus | Life Enrichment Director | Contacted upon arrival of Licensing Program Analysts. |
| Paige Pheng | Concierge | Contacted the administrator upon arrival of Licensing Program Analysts. |
Inspection Report
Complaint Investigation
Census: 148
Capacity: 170
Deficiencies: 0
May 28, 2025
Visit Reason
The inspection was an unannounced complaint investigation visit triggered by an allegation that staff did not provide authorized representatives with a 30 day eviction notice.
Findings
The investigation found the complaint to be unfounded after reviewing documentation, interviewing the resident and witnesses, and confirming that the eviction notice was served and understood. The eviction date was extended to June 10, 2025.
Complaint Details
The complaint alleged that staff did not provide authorized representatives with a 30 day eviction notice. The investigation found the allegation to be false and without reasonable basis.
Report Facts
Capacity: 170
Census: 148
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| RoseMarie Ruppert | Licensing Program Analyst | Conducted the complaint investigation and authored the report |
| Peggy Ulland | Executive Director | Met with Licensing Program Analyst during investigation and exit interview |
| Maria Arriaga | Administrator | Named as facility administrator |
| Alisa Ortiz | Licensing Program Manager | Oversaw the complaint investigation |
Inspection Report
Complaint Investigation
Capacity: 170
Deficiencies: 0
May 23, 2025
Visit Reason
The inspection was an unannounced complaint investigation visit conducted in response to a complaint received on 2023-09-05 regarding multiple allegations including resident fractures due to staff neglect, multiple falls, unlawful eviction, failure to provide itemization of fee increase, and facility internet disrepair.
Findings
The investigation included interviews with residents, staff, and former directors, and review of documents. All allegations were found to be unsubstantiated due to lack of evidence to corroborate neglect or violations. The resident's fractures and falls were not proven to be caused by staff neglect, the eviction notice was deemed lawful, fee increase notifications were properly provided, and the facility internet was found to be working.
Complaint Details
The complaint included allegations of resident sustaining fractures due to staff neglect, multiple falls due to staff neglect, unlawful eviction, failure to provide itemization of fee increase to resident's authorized representative, and facility internet disrepair. All allegations were investigated and found unsubstantiated.
Report Facts
Facility capacity: 170
Monthly charge: 4630
Care charge: 420
Proposed monthly charge: 5050
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Cassandra Mikkelson | Licensing Program Analyst | Conducted the complaint investigation and delivered final findings |
| Laura Munoz | Licensing Program Manager | Oversaw the complaint investigation |
| Robert A. Jakini | Administrator | Facility administrator met during the investigation |
| Heather Myers | Facility Director | Former Facility Director interviewed regarding resident fall incident |
Inspection Report
Complaint Investigation
Census: 138
Capacity: 170
Deficiencies: 0
May 20, 2025
Visit Reason
An unannounced visit was conducted to investigate a complaint alleging that the resident call system was not operational.
Findings
The investigation found that the resident call system was operational, with motion detectors and pendants working properly. The allegation was unsubstantiated due to lack of preponderance of evidence.
Complaint Details
The complaint alleged that the resident call system was not operational. After investigation including interviews and testing of pendants, the allegation was found unsubstantiated.
Report Facts
Capacity: 170
Census: 138
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| RoseMarie Ruppert | Licensing Program Analyst | Conducted the complaint investigation |
| Peggy Ulland | Executive Director | Met with Licensing Program Analyst during investigation |
| Maria Arriaga | Administrator | Facility Administrator named in report header |
| Alisa Ortiz | Licensing Program Manager | Named as Licensing Program Manager overseeing the investigation |
| Cauleen Ritchie | Clinical Specialist | Participated in exit interview |
Inspection Report
Complaint Investigation
Census: 138
Capacity: 170
Deficiencies: 1
May 20, 2025
Visit Reason
An unannounced complaint investigation visit was conducted to investigate allegations that facility staff do not respond to the call system in a timely manner.
Findings
The investigation found that pendant call response times were often delayed, sometimes exceeding two hours, posing an immediate health and safety risk. However, recent pendant logs showed improvement with most calls answered within twenty minutes. The allegation was substantiated and a deficiency was cited.
Complaint Details
The complaint was substantiated based on observations, record review, and interviews. The allegation that facility staff do not respond to the call system in a timely manner was confirmed.
Severity Breakdown
Type A: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Basic services shall at a minimum include 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 delayed response times to pendant calls, posing an immediate health and safety risk to persons in care. | Type A |
Report Facts
Capacity: 170
Census: 138
Plan of Correction Due Date: May 21, 2025
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| RoseMarie Ruppert | Licensing Program Analyst | Conducted the complaint investigation and authored the report |
| Alisa Ortiz | Licensing Program Manager | Named in report as Licensing Program Manager overseeing the investigation |
| Peggy Ulland | Executive Director | Met with Licensing Program Analyst during the investigation |
| Cauleen Ritchie | Clinical Specialist | Participated in exit interview with Licensing Program Analyst |
Inspection Report
Complaint Investigation
Census: 150
Capacity: 170
Deficiencies: 1
May 13, 2025
Visit Reason
An unannounced visit was conducted to investigate complaints alleging that staff did not meet a resident's catheter needs, incontinence needs, and medical needs while in care.
Findings
The investigation substantiated the allegation that staff did not meet a resident's catheter needs, citing insufficient catheter care that posed a potential risk to the resident's health and safety. The allegations regarding unmet incontinence and medical needs were found to be unsubstantiated due to insufficient evidence.
Complaint Details
The complaint investigation was triggered by allegations that staff did not meet a resident's catheter needs, incontinence needs, and medical needs. The catheter care allegation was substantiated, while the others were unsubstantiated. The investigation included resident record reviews, staff and resident interviews, and witness statements.
Severity Breakdown
Type B: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Insufficient catheter care provided to resident R1, constituting a potential risk to health, safety, and personal rights. | Type B |
Report Facts
Facility capacity: 170
Resident census: 150
Plan of Correction due date: May 30, 2025
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Kevin Saborit-Guasch | Licensing Program Analyst | Conducted the complaint investigation and authored the report |
| Sheila Santos | Licensing Program Manager | Oversaw the complaint investigation |
| Peggy Ulland | Executive Director | Facility representative who assisted during the visit |
| Maria Arriaga | Administrator | Facility administrator mentioned in the report |
Inspection Report
Complaint Investigation
Census: 145
Capacity: 150
Deficiencies: 0
Apr 11, 2025
Visit Reason
An unannounced complaint investigation was conducted following a complaint received on 2025-04-03 regarding staff not ensuring residents took their medication as prescribed.
Findings
The investigation included interviews with residents and staff and review of medication administration records. The allegation was determined to be unsubstantiated as evidence showed residents received medications as prescribed and staff followed proper procedures.
Complaint Details
The complaint alleged that staff did not ensure residents took their medication as prescribed. The investigation found no preponderance of evidence to prove the allegation, resulting in an unsubstantiated finding.
Report Facts
Capacity: 150
Census: 145
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Andrea Mendivil | Licensing Program Analyst | Conducted the complaint investigation |
| Alisa Ortiz | Licensing Program Manager | Named in report as Licensing Program Manager |
| Maria Arriaga | Administrator | Facility Administrator |
| Peggy Ulland | Executive Director | Met with during inspection |
Inspection Report
Complaint Investigation
Census: 137
Capacity: 150
Deficiencies: 0
Feb 24, 2025
Visit Reason
An unannounced complaint investigation visit was conducted in response to allegations received on 12/05/2022 regarding staff hitting, pushing residents, and not treating residents with dignity and respect.
Findings
After interviews with staff, residents, and review of records, there was insufficient evidence to substantiate the allegations. The employee in question no longer works at the facility. The complaint was determined to be unsubstantiated.
Complaint Details
The complaint involved allegations that staff hit and pushed residents and did not treat residents with dignity and respect. Eight staff interviews were conducted, with seven denying and one confirming the allegations. Resident interviews also denied the allegations. The employee had no disciplinary actions and left the facility in 2023. The complaint was unsubstantiated due to lack of preponderance of evidence.
Report Facts
Complaint Control Number: 22-AS-20221205140654
Number of staff interviews: 8
Number of resident interviews: 4
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| RoseMarie Ruppert | Licensing Program Analyst | Conducted the complaint investigation visit and interviews |
| Peggy Ulland | Executive Director | Met with Licensing Program Analyst during the visit and exit interview |
| Cauleen Ritchie | Clinical Specialist | Met with Licensing Program Analyst during the visit and exit interview |
| Heather Myers | Administrator | Facility administrator named in the report |
| Alisa Ortiz | Licensing Program Manager | Named as Licensing Program Manager on the report |
Inspection Report
Complaint Investigation
Census: 137
Capacity: 150
Deficiencies: 0
Feb 24, 2025
Visit Reason
The inspection was an unannounced complaint investigation visit triggered by a complaint received on 2021-12-28 alleging that facility staff violated residents' rights, restrained residents, and that the facility lacked PPE.
Findings
The investigation found the complaints to be unfounded after interviews with residents and staff, and observations confirmed that PPE was available and residents were not coerced or restrained regarding COVID-19 vaccination.
Complaint Details
The complaint was investigated and found to be unfounded, meaning the allegations were false, could not have happened, or lacked reasonable basis.
Report Facts
Complaint Control Number: 22
Capacity: 150
Census: 137
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| RoseMarie Ruppert | Licensing Program Analyst | Conducted the complaint investigation and follow-up visits |
| Peggy Ulland | Executive Director | Met with the Licensing Program Analyst during the investigation and exit interview |
| Heather Myers | Administrator | Facility administrator named in the report |
| Alisa Ortiz | Licensing Program Manager | Named as Licensing Program Manager overseeing the investigation |
Inspection Report
Complaint Investigation
Census: 137
Capacity: 150
Deficiencies: 1
Feb 24, 2025
Visit Reason
The visit was an unannounced complaint investigation triggered by a complaint received on December 28, 2021, alleging that the facility lacked appropriate staffing.
Findings
The investigation included interviews with residents and staff, all of whom denied the staffing issues alleged. The facility was unable to provide staffing schedules from November 2021 through January 2022 due to a software change, resulting in a technical violation. The allegation of staffing shortages was unsubstantiated due to lack of preponderance of evidence.
Complaint Details
The complaint alleged that the facility lacked appropriate staffing, that staff were required to work while sick and seven days a week to avoid using an outside staffing agency. The complaint was found unsubstantiated.
Deficiencies (1)
| Description |
|---|
| Technical violation for missing staffing records from November 2021 through January 2022 due to software change. |
Report Facts
Capacity: 150
Census: 137
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Peggy Ulland | Executive Director | Met with Licensing Program Analyst during investigation and exit interview |
| RoseMarie Ruppert | Licensing Program Analyst | Conducted the complaint investigation and follow-up visit |
| Alisa Ortiz | Licensing Program Manager | Named as Licensing Program Manager on report |
Inspection Report
Annual Inspection
Census: 133
Capacity: 150
Deficiencies: 0
Jan 30, 2025
Visit Reason
The visit was an unannounced annual required inspection conducted to evaluate compliance with regulatory standards for the facility.
Findings
The inspection found no deficiencies in the areas inspected, including resident care, facility safety, medication storage and administration, and physical plant conditions. All required documentation was present and the facility was observed to be clean and well-maintained.
Report Facts
Residents on hospice: 11
Resident files reviewed: 13
Staff files reviewed: 8
Water temperature: 117.6
Water temperature: 116.7
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Michael Tea | Licensing Program Analyst | Conducted the inspection and authored the report |
| Peggy Ulland | Executive Director | Assisted during the inspection and participated in exit interview |
| Matt Yem | Maintenance Director | Assisted in touring the facility during the inspection |
Inspection Report
Complaint Investigation
Census: 123
Capacity: 150
Deficiencies: 0
Dec 30, 2024
Visit Reason
An unannounced complaint investigation visit was conducted in response to a complaint received on 05/25/2022 alleging that facility staff did not provide adequate supervision to a resident in care.
Findings
The investigation included staff interviews, resident file review, and medical record subpoena. It was determined that the resident was able to follow instructions and self-feed, and staff were nearby and contacted emergency personnel immediately. The allegation was found to be unsubstantiated due to lack of preponderance of evidence.
Complaint Details
The complaint alleged inadequate supervision of a resident who spilled hot tea on themselves resulting in third degree burns. The investigation found no sufficient evidence to substantiate the allegation.
Report Facts
Capacity: 150
Census: 123
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Peggy Ulland | Executive Director | Met with during investigation and exit interview |
| RoseMarie Ruppert | Licensing Program Analyst | Conducted complaint investigation |
| Alisa Ortiz | Licensing Program Manager | Named in report as Licensing Program Manager |
Inspection Report
Complaint Investigation
Census: 123
Capacity: 150
Deficiencies: 1
Nov 18, 2024
Visit Reason
Unannounced complaint investigation visit conducted due to an allegation that staff failed to provide supervision resulting in not meeting residents' needs.
Findings
The investigation found no preponderance of evidence to substantiate the allegation. Staff interviews and review of records indicated no current staffing issues, and the alleged failure of supervision was unsubstantiated. A technical violation was cited for missing staffing schedules from November and December 2022, but it did not pose an immediate or potential health risk.
Complaint Details
The complaint alleged staff failed to provide supervision resulting in unmet resident needs. Interviews with staff and witnesses did not support the allegation. Staff member S1 resigned in 2023 and had no disciplinary actions. The allegation was unsubstantiated.
Deficiencies (1)
| Description |
|---|
| Missing staffing schedules from November and December 2022 due to software change. |
Report Facts
Capacity: 150
Census: 123
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| RoseMarie Ruppert | Licensing Program Analyst | Conducted the complaint investigation and authored the report. |
| Peggy Ulland | Executive Director | Met with investigators during the visit and participated in exit interview. |
| Heather Myers | Administrator | Named as facility administrator in report header. |
| Alisa Ortiz | Licensing Program Manager | Named as Licensing Program Manager overseeing the investigation. |
Inspection Report
Census: 123
Capacity: 150
Deficiencies: 0
Nov 18, 2024
Visit Reason
The visit was an unannounced case management visit to deliver amended reports from August 15, 2024.
Findings
Licensing Program Analysts met with the Executive Director and provided an exit interview along with copies of the amended reports. No deficiencies or violations were noted in the report.
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Peggy Ulland | Executive Director | Met with Licensing Program Analysts during the visit. |
| RoseMarie Ruppert | Licensing Program Analyst | Conducted the unannounced case management visit. |
| Fred Arias | Licensing Program Analyst | Conducted the unannounced case management visit. |
| Maria Arriaga | Administrator | Named as facility administrator. |
Inspection Report
Complaint Investigation
Census: 121
Capacity: 150
Deficiencies: 0
Nov 1, 2024
Visit Reason
Unannounced complaint investigation visit conducted in response to allegations received on 09/13/2022 regarding staff training on emergency disaster response and adequacy of staffing to meet residents' needs.
Findings
The investigation found that all staff interviewed stated they were trained on emergency response and fire/disaster drills were conducted regularly. Staffing levels were adequate at the time of the visit, with no current staffing issues. The allegations were determined to be unsubstantiated due to lack of preponderance of evidence.
Complaint Details
The complaint alleged that facility staff were not trained to conduct proper emergency disaster response and that the facility failed to provide adequate staffing to meet residents' needs. The investigation found no evidence to substantiate these allegations.
Report Facts
Facility capacity: 150
Resident census: 121
Staff observed on 09/21/2022: 4
Staff observed on 09/21/2022: 5
Staff observed on 09/21/2022: 2
Staff observed on 09/21/2022: 3
Residents observed in Activity Room: 15
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| RoseMarie Ruppert | Licensing Program Analyst | Conducted the complaint investigation and authored the report |
| Peggy Ulland | Executive Director | Facility representative met during investigation and exit interview |
| Alisa Ortiz | Licensing Program Manager | Named as Licensing Program Manager on report |
Inspection Report
Follow-Up
Census: 118
Capacity: 150
Deficiencies: 1
Oct 10, 2024
Visit Reason
The visit was an unannounced follow-up to clear the deficiency cited during the 10-day complaint investigation conducted on September 25, 2024.
Findings
The facility complied with the terms of the plan of correction related to maintenance and operation, specifically resolving the elevator malfunction issue. The deficiency is now cleared.
Complaint Details
The visit was conducted to clear deficiencies cited during a complaint investigation on September 25, 2024.
Deficiencies (1)
| Description |
|---|
| Elevator malfunctioning issue resolved |
Report Facts
Capacity: 150
Census: 118
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Jessica Cho | Licensing Program Analyst | Conducted the follow-up inspection |
| Tina Tanus | Life Enrichment Director | Met with Licensing Program Analyst during the inspection and involved in exit interview |
| Peggy Ulland | Executive Director | Participated in exit interview by telephone |
Inspection Report
Complaint Investigation
Census: 115
Capacity: 150
Deficiencies: 1
Sep 25, 2024
Visit Reason
The inspection was an unannounced 10-day complaint investigation triggered by an allegation that staff did not ensure the elevator was working properly.
Findings
The investigation found that one of the two elevators was malfunctioning due to a power issue with the Program Logic Control (PLC) Board. Despite previous repair attempts, the elevator remained non-functional at the time of the visit, posing a potential health, safety, or personal rights risk to residents. The allegation was substantiated.
Complaint Details
The complaint was substantiated based on observations, interviews, and record review. The elevator was not working properly due to unresolved electrical issues beyond the scope of the initial repair technician. Poor communication and misunderstanding of the repair contract delayed the elevator repair.
Severity Breakdown
Type B: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Failure to maintain the elevator in safe and good repair, posing a potential health, safety, or personal rights risk to persons in care. | Type B |
Report Facts
Capacity: 150
Census: 115
Deficiency Type: 1
Plan of Correction Due Date: Oct 4, 2024
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Jessica Cho | Licensing Program Analyst | Conducted the complaint investigation and authored the report |
| Peggy Ulland | Executive Director | Facility representative interviewed during the investigation and exit interview |
| Matt Yem | Maintenance Director | Observed elevator malfunction and provided video evidence |
Inspection Report
Annual Inspection
Census: 111
Capacity: 150
Deficiencies: 0
May 6, 2024
Visit Reason
The inspection was a subsequent Annual Required visit following a prior 10-day complaint visit, conducted to evaluate compliance with licensing regulations.
Findings
The facility was found to be in compliance with no citations issued. Observations included proper food supply storage, clean and operational cooking and bathing facilities, secure medication storage, unobstructed emergency exits, and compliant resident and personnel files.
Report Facts
Residents receiving hospice care: 12
Approved hospice waiver capacity: 15
Bedridden resident capacity: 44
Fire extinguisher last serviced: Apr 30, 2024
Pest control last serviced: Apr 10, 2024
Last fire drill date: May 2, 2024
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Rosie Quiroz | Licensing Program Analyst | Conducted the inspection and authored the report |
| Cauleen Ritchie | Regional Clinical Specialist | Met with Licensing Program Analyst during inspection |
| Peggy Ulland | Interim Director | Met with Licensing Program Analyst during inspection and participated in exit interview |
| Jamie Pyles | Health and Wellness Director | Met with Licensing Program Analyst during inspection and participated in exit interview |
| Dawn Blankenship | Regional Director of Operations | Arrived during the inspection visit |
| Maria Arriaga | Administrator | Facility Administrator with certificate expiring November 7, 2024 |
Inspection Report
Follow-Up
Census: 112
Capacity: 150
Deficiencies: 1
Apr 18, 2024
Visit Reason
This was a subsequent unannounced visit following a 10-day visit related to complaint control #22-AS-20240411095716 to assess compliance with previously identified deficiencies.
Findings
The inspection found that the facility failed to maintain a comfortable temperature in the activity room, with temperatures observed between 80 and 82 degrees Fahrenheit, which was not controlled locally. This deficiency was cited under Title 22, Division 6 of the California Code of Regulations.
Complaint Details
The visit was complaint-related, following complaint control #22-AS-20240411095716. The deficiency regarding temperature control was substantiated and cited.
Deficiencies (1)
| Description |
|---|
| Failure to maintain a comfortable temperature for residents in the activity room, with temperatures observed up to 82 degrees Fahrenheit. |
Report Facts
Temperature observed: 80
Temperature observed: 82
Temperature observed: 78
Census: 112
Total Capacity: 150
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Jamie Pyles | Health and Wellness Director | Met during inspection and discussed purpose of visit; involved in temperature control issue |
| Matt Yem | Maintenance Director | Arrived to activity room to decrease room temperature during inspection |
Inspection Report
Census: 104
Capacity: 150
Deficiencies: 0
Mar 5, 2024
Visit Reason
This unannounced Case Management – Incident inspection was conducted for a health and safety check and to follow up on a self-reported incident involving Staff 1 received by the Orange County Regional Office on 03/05/2024.
Findings
The inspection found no imminent health and safety concerns. The facility was clean and organized, with proper supplies and storage of medications, sharps, and toxins. No deficiencies were cited during this inspection.
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Jamie Pyles | Health Service Director | Met during inspection and participated in exit interview. |
| Sacha Dunlap | Business Office Manager | Met during inspection. |
| Marissa Drinkhouse-Quintana | Administrator | Interviewed by phone regarding incident and inspection purpose. |
| Rosie Quiroz | Licensing Program Analyst | Conducted the inspection. |
Inspection Report
Follow-Up
Census: 109
Capacity: 150
Deficiencies: 0
Sep 11, 2023
Visit Reason
The visit was conducted as a follow-up on a self-reported incident regarding resident R1 that occurred on September 06, 2023.
Findings
The Licensing Program Analyst found no immediate or safety risks in or out of the facility during the visit. The resident involved in the incident was assessed and sent to the hospital for observation and remains there.
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Ruth Martinez | Licensing Program Analyst | Conducted the case management visit and investigation of the incident. |
| Dawn Blankenship | Regional Director of Operations | Met with the Licensing Program Analyst during the visit. |
| Robert A. Jakini | Administrator | Facility administrator named in the report header. |
Inspection Report
Complaint Investigation
Census: 109
Capacity: 150
Deficiencies: 0
Jul 27, 2023
Visit Reason
The inspection was an unannounced complaint investigation visit triggered by allegations received on 2023-06-12 regarding insufficient incontinence supplies, failure to provide call buttons to residents, and inadequate staffing to meet residents' needs.
Findings
The investigation found that the facility had ample incontinence supplies and call buttons were available as needed. Staffing levels were verified and found consistent with the administrator's statements, though some staff reported staffing issues while others denied them. Due to conflicting information, the allegations were deemed unsubstantiated and ultimately determined to be unfounded with no deficiencies cited.
Complaint Details
The complaint investigation was unannounced and conducted by Licensing Program Analyst Kimberly Lyman. Allegations included insufficient incontinence supplies, failure to provide call buttons, and inadequate staffing. The investigation included facility tours, interviews with staff, residents, and witnesses, and review of documentation. The allegations were found unsubstantiated and ultimately unfounded.
Report Facts
Capacity: 150
Census: 109
Staffing levels: 3
Staffing levels: 1
Staffing levels: 2
Staffing levels: 1
Staff survey: 5
Staff survey: 10
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Robert A. Jakini | Administrator / Executive Director | Met with during investigation and provided information on staffing and supplies |
| Kimberly Lyman | Licensing Program Analyst | Conducted the complaint investigation visit |
| Alisa Ortiz | Licensing Program Manager | Oversaw the complaint investigation |
Inspection Report
Complaint Investigation
Census: 103
Capacity: 150
Deficiencies: 0
Jul 21, 2023
Visit Reason
The inspection visit was conducted as a 10-day inspection regarding complaint control #22-AS-20230717085332 to follow up on previous complaint investigations #22-AS-20220525095746 and #22-AS-20221207111938.
Findings
During the inspection, the Licensing Program Analyst and Ombudsman Representative toured the Assisted Living and Memory Care Unit, conducted interviews, and made facility observations. An exit interview was conducted with the Executive Director and a copy of the report was provided.
Complaint Details
The visit was a follow-up complaint investigation related to complaint control numbers 22-AS-20220525095746 and 22-AS-20221207111938. No substantiation status was stated.
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Robert A. Jakini | Executive Director | Met with during inspection and exit interview. |
| Rosie Quiroz | Licensing Program Analyst | Conducted inspection and interviews. |
| Linda Bock | Ombudsman Representative | Conducted interviews and facility observations. |
| Alisa Ortiz | Licensing Program Manager | Named in report header. |
Inspection Report
Complaint Investigation
Census: 116
Capacity: 150
Deficiencies: 0
Jun 23, 2023
Visit Reason
An unannounced complaint investigation was conducted in response to an allegation that a resident was being illegally evicted from the facility.
Findings
The investigation found that the allegation of illegal eviction was unfounded. Documentation and interviews revealed that no eviction notice was sent to any current resident and the eviction process follows a 30-day notice as per regulation 87224.
Complaint Details
The complaint alleging illegal eviction of a resident was investigated and determined to be unfounded based on record reviews and interviews.
Report Facts
Capacity: 150
Census: 116
Complaint Control Number: 22-AS-20230619125734
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Andrea Mendivil | Licensing Program Analyst | Conducted the complaint investigation |
| Robert Jakini | Executive Director | Interviewed during the investigation |
| Alisa Ortiz | Licensing Program Manager | Named in report as Licensing Program Manager |
Inspection Report
Complaint Investigation
Census: 121
Capacity: 150
Deficiencies: 0
Apr 11, 2023
Visit Reason
Unannounced case management health and safety check visit conducted in conjunction with complaint 22-AS-20230410115728.
Findings
No hazards or safety concerns posing a threat to residents were observed. No deficiencies or citations were issued during this visit.
Complaint Details
Visit was conducted in conjunction with complaint 22-AS-20230410115728. No deficiencies or citations were issued, indicating no substantiated violations.
Report Facts
Residents in care: 121
Memory care residents: 37
Assisted living residents: 84
Residents on hospice care: 11
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Robert A. Jakini | Administrator | Met with Licensing Program Analysts during inspection |
| Rosie Quiroz | Licensing Program Analyst | Conducted inspection and exit interview |
| Alvaro Ramirez | Licensing Program Analyst | Conducted inspection and exit interview |
Inspection Report
Complaint Investigation
Census: 120
Capacity: 150
Deficiencies: 1
Apr 4, 2023
Visit Reason
The inspection was an unannounced complaint investigation visit triggered by allegations received on 2023-01-23 regarding failure to seek medical attention for a resident, not following a resident's prescribed diet, and staff not properly trained.
Findings
The investigation found the allegations regarding failure to seek medical attention and not following the prescribed diet to be unsubstantiated due to lack of corroborating evidence. However, the allegation that facility staff were not properly trained was substantiated based on incomplete staff training records and interviews.
Complaint Details
The complaint investigation was initiated due to allegations that the facility failed to seek medical attention for a resident, did not follow a resident's prescribed diet, and that staff were not properly trained. The first two allegations were deemed unsubstantiated, while the staff training allegation was substantiated.
Severity Breakdown
Type B: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| 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. | Type B |
Report Facts
Capacity: 150
Census: 120
Plan of Correction Due Date: Apr 14, 2023
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Patricia Velazquez | Licensing Program Analyst | Conducted the complaint investigation and authored the report |
| Robert Jakini | Executive Director | Met with Licensing Program Analyst during the investigation and exit interview |
| Sheila Santos | Licensing Program Manager | Named as Licensing Program Manager overseeing the investigation |
Inspection Report
Complaint Investigation
Census: 121
Capacity: 150
Deficiencies: 1
Dec 12, 2022
Visit Reason
The visit was an unannounced case management inspection conducted to investigate complaints identified by Complaint Control Numbers 22-AS-20221205140654 and 22-AS-20221207111938.
Findings
A citation was issued for failure to ensure private interviews with staff, as the Chief Executive Officer admitted to listening to a private interview with a staff member. The licensee was reminded of the importance of private interview settings and issued a citation under Title 22 Division 6, Section 87755(b).
Complaint Details
The visit was complaint-related, investigating two complaint control numbers. The citation was issued based on the CEO admitting to listening to a private interview, violating interview privacy requirements.
Deficiencies (1)
| Description |
|---|
| Failure to ensure provisions for private interviews with any resident or staff member, evidenced by CEO listening to a private interview with Staff 1. |
Report Facts
Capacity: 150
Census: 121
Plan of Correction Due Date: 4
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Robert Jakini | Executive Director | Met with Licensing Program Analysts during the visit |
| Luis Serrano | Chief Executive Officer | Admitted to listening to private interview with staff, cited for violation |
| Heather Myers | Administrator | Facility administrator listed in report header |
Inspection Report
Follow-Up
Census: 98
Capacity: 150
Deficiencies: 1
Sep 21, 2022
Visit Reason
Subsequent visit following an unannounced visit addressing a complaint related to COVID-19 positive cases at the facility.
Findings
The visit addressed 14 COVID-19 positive cases reported between 7/25/2022 and 8/9/2022. The facility was cited for failure to report epidemic outbreaks within 24 hours as required by regulations.
Complaint Details
Visit was complaint-related addressing Complaint control #22-AS-20220913154817. The complaint involved 14 COVID-19 positive cases reported on 8/9/2022.
Severity Breakdown
Type B: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Failure to report epidemic outbreaks within 24 hours to the licensing agency and local health officer as required by Title 22, Division 6 of the California Code of Regulations. | Type B |
Report Facts
COVID-19 positive cases: 14
Deficiencies cited: 1
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Sheila Fike | Executive Director | Met with Licensing Program Analyst during visit and cited in deficiency finding |
Inspection Report
Complaint Investigation
Census: 78
Capacity: 150
Deficiencies: 2
May 17, 2022
Visit Reason
The inspection was an unannounced complaint investigation visit triggered by an allegation that a resident sustained multiple falls resulting in consequential rib fractures.
Findings
The investigation found that Resident 1, diagnosed with Alzheimer's and Dementia, experienced multiple falls between 1/21/2022 and 1/24/2022, resulting in fractured ribs and other injuries. The facility failed to provide timely medical treatment and adequate supervision. However, the allegation was ultimately deemed unsubstantiated due to insufficient preponderance of evidence.
Complaint Details
The complaint alleged that a resident sustained multiple falls with consequential rib fractures. The investigation was unsubstantiated, meaning there was not enough evidence to prove the alleged violation did or did not occur.
Severity Breakdown
Type A: 2
Deficiencies (2)
| Description | Severity |
|---|---|
| Basic Services-87464(f)(1): Facility failed to accurately assess and provide timely medical treatment for Resident 1 after falls. | Type A |
| Care of Persons with Dementia-87705(c)(4): Facility failed to ensure adequate direct care staff and supervision to support Resident 1's physical, safety, and health care needs. | Type A |
Report Facts
Capacity: 150
Census: 78
Falls documented: 3
Plan of Correction Due Date: May 18, 2022
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Richard Mariona | Health Service Director | Named in relation to assessment and follow-up of Resident 1's falls |
| Sheila Fike | Executive Director | Participated in exit interview and facility management |
Inspection Report
Complaint Investigation
Census: 78
Capacity: 150
Deficiencies: 2
May 17, 2022
Visit Reason
An unannounced complaint investigation visit was conducted in response to an allegation that a resident sustained multiple falls resulting in consequential rib fractures.
Findings
The investigation found that Resident 1, diagnosed with Alzheimer's and Dementia, experienced three documented falls between 1/21/22 and 1/24/22, resulting in fractured ribs and other injuries. However, the allegation was deemed unsubstantiated due to insufficient preponderance of evidence to prove the violation occurred.
Complaint Details
The complaint alleged that a resident sustained multiple falls with consequential rib fractures. The investigation was unannounced and involved interviews, document reviews, and observations. The allegation was ultimately unsubstantiated due to lack of sufficient evidence.
Severity Breakdown
Type A: 2
Deficiencies (2)
| Description | Severity |
|---|---|
| Failure to provide adequate care and supervision, including timely medical treatment after falls, as required by CCR 87464(f)(1). | Type A |
| Failure to ensure adequate direct care staff to support residents' physical, safety, and health care needs as identified in appraisals, as required by CCR 87705(c)(4). | Type A |
Report Facts
Deficiencies cited: 2
Resident falls: 3
Facility capacity: 150
Resident census: 78
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Richard Mariona | Health Service Director | Named in relation to assessment and oversight of Resident 1's falls and medical treatment. |
| Sheila Fike | Executive Director | Participated in exit interview and facility management. |
Inspection Report
Complaint Investigation
Census: 71
Capacity: 150
Deficiencies: 1
Mar 22, 2022
Visit Reason
An unannounced complaint investigation visit was conducted following a complaint received on 2021-10-05 regarding a resident sustaining injury due to a fall or improper care.
Findings
The investigation substantiated that Resident #1 suffered an unwitnessed fall and subsequent injury. Video evidence showed staff member S1 roughly handling the resident, resulting in a pelvic fracture. S1 was untruthful during interviews and was not properly associated with the facility. The facility failed to ensure the resident's personal rights and safety, posing immediate health and safety risks.
Complaint Details
The complaint alleging that a resident sustained injury due to a fall or improper care was substantiated based on video evidence, interviews, and medical documentation. The resident was diagnosed with a pelvic fracture after staff mishandling. The staff member involved was hired through a temp agency and lacked required training and paperwork.
Severity Breakdown
Type A: 1
Deficiencies (1)
| Description | Severity |
|---|---|
| Failure to ensure Resident #1's personal rights were not violated as staff member S1 was observed yanking on the resident's extremities and shoulder while assisting with ADLs, causing injury. | Type A |
Report Facts
Capacity: 150
Census: 71
Deficiency Type: 1
Plan of Correction Due Date: Due date for correction was 2022-03-25
Employees Mentioned
| Name | Title | Context |
|---|---|---|
| Rosie Quiroz | Licensing Program Analyst | Conducted the complaint investigation |
| Alisa Ortiz | Licensing Program Manager | Oversaw the complaint investigation |
| Heather Myers | Executive Director | Facility administrator involved in exit interview |
| Richard Mariona | Health Services Director | Facility staff met during investigation |
| S1 | Staff member observed mishandling resident, hired via temp agency, contract terminated |
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