Parkview RCH #2

Type of visit: Required - 1 Year

On 03/24/26, LPA Grace Donato made an unannounced annual visit to the facility. LPA met with Administrator Elma Pascula. LPA explained the purpose of the visit. LPA toured the facility inside and outside including all of resident rooms and kitchen area. LPA observed residents watching TV in the living room. While touring the facility it was observed that the room temperature was at 70 deg F. Hot water temperature is at 108 degF. The facility is observed to be clean, odorless, and well maintained. All passageways are unobstructed. Residents bedrooms were observed to be well organized and fully furnished with adequate lighting. Sharps and toxic materials were observed to be locked. Food supply was observed with an adequate two day perishable and seven day non-perishable food supply. Carbon monoxide/ smoke detectors, and fire extinguisher were present throughout the facility. Facility has an updated log for emergency drill which is done every quarter. Four resident records and two staff records were reviewed. Staff have criminal record and fingerprint clearances on file. Staff have current First Aid/CPR certifications on file and updated trainings. Resident records were reviewed and were observed to be complete. All medication logs are complete and updated. No deficiencies are cited at this time. Report is reviewed and a copy is providedthe state’s words, verbatim · CDSS document, Mar 24, 2026

Type of visit: Required - 1 Year

On March 13, 2025, at 08:45 AM, the Licensing Program Analyst (LPA) Kiran Jain arrived unannounced at the facility to conduct a Required 1-Year Annual inspection. The LPA met with the Administrator, Elma Pacursa, and disclosed the purpose of the inspection. The Administrator informed the LPA that the facility had (5) residents in care and (3) staff members present at the time. The Licensee, Helen Ng arrived shortly after. At 9:23 AM, the LPA initiated a walk-through of the facility, accompanied by the Administrator. LPA inspected the kitchen and found it clean, with no food preparation and cooking in progress at the time. The appliances were checked and observed to be in working order. The LPA inspected a locked cabinet containing knives and sharp objects. The refrigerator and pantry cabinets were inspected, and sufficient supplies of fresh perishable food for (2) days and nonperishable staples for (7) days were observed. No expired food or stored medications were noted. LPA inspected the dining area adjacent to the kitchen and found it clean. The dining table and chairs were observed to accommodate the residents, and all the furniture was in good repair. (4) residents were observed eating breakfast. LPA inspected the fire extinguisher mounted on the wall in the kitchen and found it fully charged, with the last service tag dated 06/04/2024. The Administrator tested the smoke and carbon monoxide detector located in the hallway in the LPA's presence, and it was found to be functional. Additional smoke and carbon monoxide detectors were observed in all bedrooms and common areas of the facility during the visit. LPA inspected the living room and observed it clean, with all furniture in good repair. There was a sofa set and a television in the living room. (1) resident was observed watching TV. Continued on LIC809-C There were (6) bedrooms and (2½) bathrooms designated for residents' use. All (6) resident rooms were single occupancy. LPA inspected all (6) resident rooms and found them clean, well-lit, and equipped with the required furniture. All exit doors had Auditory alarms for notification. LPA inspected (2½) bathrooms and found them clean, sanitary, and in good working condition. The bathrooms contained soap, grab bars, paper towels, a trash can, a shower chair, and non-slip flooring. The hot water temperature at the sink faucet measured 118.7°F in bathroom #1 and 149.8°F in bathroom #2. Bathroom closets were observed to contain clean linens and towels for residents’ use. LPA inspected the garage and found it clean. A break room for staff with sofa was observed. A washer, a dryer, a refrigerator, a freezer containing additional food supplies, wheelchairs, mattresses, a cabinet with detergents, disinfectants, and cleaning supplies, and storage cabinets with incontinence supplies, and paper products were observed. LPA toured the backyard area and found ramps and passageways in good condition, clear of obstructions, with no blocking or tripping hazards. The backyard has a set of a patio table, chairs, and shaded areas for resident use. No bodies of water and no tripping hazards were noted. LPA reviewed (5) staff personnel records and (5) resident records. The LPA observed that 4 of 5 residents with dementia did not receive an annual Physician assessment and did not have Appraisal Needs and Services Plan. LPA observed that 5 of 5 staff members had LIC 508 Criminal Record Statements and LIC 503 Health Screening and confirmed that 5 of 5 staff members were associated with the facility. LPA observed a locked centrally stored medication cabinet inside the kitchen area. Medications were organized in separate bins for each resident. All medication bottles were properly labeled. Centrally Stored Medication Records were reviewed and found to be complete. LPA inspected the first aid kit and found it fully stocked. Emergency Drill Logs were reviewed, and it was observed that Emergency Disaster Drills were conducted quarterly, with the most recent drill completed on 01/05/2025. Continued on LIC809-C The following updated forms are requested to be submitted to CCLD by 03/20/2025: LIC 500: Personnel Report LIC 308: Designation of Facility Responsibility Certificate of Liability Insurance Updated Facility Sketch (Floor Plan) Administrator Certificate(s) The deficiencies are being cited based on LPA observations, records reviewed, and interviews conducted in accordance with the California Code of Regulations, Title 22, see LIC809D. An exit interview was conducted with the Licensee. A copy of this report was left with the Licensee, Helen Ng, whose signature on this form confirms receipt of the report.the state’s words, verbatim · CDSS document, Mar 13, 2025

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) Manuel Monter conducted an unannounced annual inspection visit, and met with Lead staff Elma Pacursa, S1. S1 contacted facility ADM and informed her about LPA's visit. ADM arrived shortly after. During the visit, LPA observed 6 residents and 3 staff. ADM informed LPA that she could not stay due to appointment. ADM stated S1 could sign on her behalf. As LPA approached the entrance of the home, LPA stepped on the wooden planks of the floor, directly next to the front door and two of them were loose and sinked. LPA showed ADM the sinking wooden planks. ADM stated she would remove them and fix it. As LPA entered the home, Staff S2 introduced him/herself. LPA checked the facility personnel report summary and staff S2 is not associated with the facility. LPA checked guardian and staff S2 is not associated with the facility. LPA reviewed facility LIC500, dated January 17, 2023. The form states S2 is an on call care giver since 2022 and is also a live in. LPA interviewed staff S2. S2 stated he/she is not a full time employee and is a reliever. S2 stated he/she worked today and last week. LPA toured the facility inside out with S1 which included the Living room, kitchen, dining room, 3 restrooms and 6 residents bedrooms. The staff area of the facility was also inspected. The front yard and backyard were inspected. There was no obstruction to block the walkways. Two-day perishable food supplies and seven day nonperishable food supplies were observed. LPA observed the medication storage area, knives storage area, and cleaning product storage area as locked and inaccessible to residents in care. Room temperature was at 70 degrees F, and hot water temperature was measured at 110 degrees F in both resident bathrooms. Page 1 Out of 2. Fire extinguisher was serviced in July 20, 2023. The facility was equipped with smoke and carbon monoxide detectors. Smoke detectors was tested by S1, and were functional. LPA observed facility first aid kit and facility fire/earthquake drill log. The facility's last drill was on November 10, 2023. LPA reviewed facility records for 3 staff. LPA reviewed 3 residents records. LPA requested to review weight records for residents R1-R3. S1 stated the facility does not have a weight record for residents. Based on a review of R2's physicians report, dated May 1, 2023, R2 has dementia. LPA reviewed resident R2's Needs and services plan, dated March 4, 2020. S1 stated the facility does not have an updated Needs and services plan for this year. LPA reviewed 3 resident medications and centrally stored medication records. While reviewing resident R3's medications, LPA observed that R3's centrally stored medication log stated medication #1 had a start date of 9/29/2023. LPA requested Staff S1 to count the medication. Medication #1 had a total of 36 pills. S1 stated she made a mistake and did not update the centrally stored medication log, when she got a new refill. LPA observed medication #2 had a start date of 12/5/2023, based on the centrally stored medication log. LPA requested S1 count the medication. Medication #2 had 25 pills. Further investigation showed that medication #2 had written on the bottom 12/31. S1 stated she made a mistake and did not update the centrally stored medication log with the correct information. LPA conducted interviews with 1 staff (S1) and 2 residents. Deficiencies cited during today's visit. This report was reviewed with Lead staff Elma Pacursa and a copy of the signed report was provided. A civil penalty is being assessed for the amount of $500 ($100 per day x 5 days = $500) for S1 working and residing in the facility without association. Appeal rights were provided. Page 2 Out of 2.the state’s words, verbatim · CDSS document, Mar 5, 2024