Parkview Village II

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) De Leon arrived at 2:45pm to conducted a 1 year annual visit to the facility above. LPA met with Administrator Enos Patacsil and explained the purpose of the visit. A tour of the inside and outside of the facility was conducted with Administrator. The following was inspected and noted during the annual visit: Infection Control: The facility has a current Infection Control Plan. The facility has a sign in and out clipboard for visitors at entry with hand sanitizer. The bathrooms have toilet paper, paper towels, hand soap, and hand washing signs. The facility has EPA approved disinfectants spray and cleaners. The facility has a 30 day supply of PPE. Quarantined or isolated individuals will have meals and medication delivered to rooms. Staff are trained on infection control and the use of Personal Protective Equipment (PPE). Operational Requirements: The facility has a current plan of operation on file with the department. The Facility is operating in compliance with the granted fire clearance. The facility has current liability insurance and expires on 05/01/2027. The facility is approved for a capacity of 6 with 6 Non-Ambulatory of which 6 may be bedridden. Hospice approved for 3. Physical Plant & Environment Safety: The facility is a 5 bedroom and 3 bathrooms currently occupying 6 residents and employs 3 full time live in staff, 3 Administrators and 6 back up staffing. LPA was authorized to enter and inspect facility. The facility has smoke and carbon monoxide detectors with a sprinkler system.. The lighting and lamps are sufficient for the use of the facility and for resident comfort. The showers have non-skid mats. Toilet, hand washing and bathing facilities are operational and secured grab bars are present. The pathways are clear of any obstructions. Facility is well lit inside and outside for safety. Disinfectant, cleaning solutions and poisons are inaccessible to residents in care locked in laundry room. The facility has sufficient space inside and outside for activities and visiting. The facility has an fenced backyard for client use with plenty of shade. The facility has telephone and internet service for resident use. Continued 809-C Staffing: The facility employes 3 full time live in staff, 3 Administrators and 6 back up staffing. Staff records are kept confidential. Files reviewed had current Personnel Records/Application, Health screening with TB results, Criminal Record statements, and Finger print clearance/Associations/exemptions. Administrator file was reviewed for current Administrator Certificate expires 01/21/2027. Personnel Records & Training: The facility keeps confidential files for staff members. Staff have training with 20 plus hours meeting topics completed 2025-2026. Residents Rights and Information: CCL and LTCO Complaint posters are posted. The facility has a posting board on the wall in the entry with all required postings posted. Planned Activities: The facility has a cupboard with puzzles, games, books and TV in rooms and living rooms. Residents walk around pathways in the back yard. There is enough space inside and outside for activities. Residents do the activities they like and want to do. Food Service: The facility handles and prepares food safely. The facility has 2 day perishables and 7 day non-perishables to meet the food service requirement. The freezer is kept at 0 degrees and the refrigeration is kept at 40 degrees or lower. All food is covered, stored and marked appropriately. Food, snacks and drinks are available when the residents want them. Emergency supply of food and water is available. Cleaning solutions and equipment are stored separately from food supplies. Kitchen staff are observed for personal hygiene and food sanitation practices. Kitchen stove/hood and cupboards needed additional cleaning. Incidental Medical and Dental Services: Facility provides or assists in providing transportation to medical and dental appointments when needed. The facility uses the Medication Administration Record (MAR) along with the Centrally Stored Medication and Destruct Records (CSMDR). LPA checked medications for all 6 residents, medication labels were not altered and medications were stored in original containers. Resident Records & Incident Reports: The facility keeps separate files on each resident confidentially. Facility does submit incident reports to the department when required. LPA reviewed 5 resident files for signed Admission Agreements, Personal Rights, Safeguard for property and valuables, LIC. 602A Physicians report, Pre-appraisals, Appraisals Needs and Services Plan, Emergency and ID forms, all forms were legible and completed in separate confidential binders for each resident in care. Continued 809-C Disaster Preparedness: The current emergency disaster forms were posted. The facility conducts quarterly disaster drills. The fire extinguishers was charged and last inspected on 09/30/2025, company will be coming out to before the end of the month. Emergency exits and telephone numbers were posted. A set of keys is available for staff on all shifts to access full facility in an emergency. Residents with Special Health Needs: The facility does accept dementia residents in care. All items that could pose a danger, sharps, cleaners were locked or in accessible to residents in care. The facility has no residents currently on oxygen. The facility has 1 hospice residents in care. Hospice care plans are kept on file and up to date. The facility currently has 2 residents receiving Home Health services. Home Health services records are kept on file. The facility does not have delayed egress. Exit doors have alarms. Exit interview conducted, copy of report printed for Administrator.the state’s words, verbatim · CDSS document, Sep 3, 2026

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) De Leon arrived at 2:20pm to conducted a 1 year annual visit to the facility above. LPA met with Back up Administrator Crystal Karen Thavaj and explained the purpose of the visit. A tour of the inside and outside of the facility was conducted with Administrator. The following was inspected and noted during the annual visit: Infection Control: The facility has a current Infection Control Plan. The facility has a sign in and out clipboard for visitors at entry with hand sanitizer. The bathrooms have toilet paper, paper towels, hand soap, and hand washing signs. The facility has EPA approved disinfectants spray and cleaners. The facility has a 30 day supply of PPE. Quarantined or isolated individuals will have meals and medication delivered to rooms. Staff are trained on infection control and the use of Personal Protective Equipment (PPE). Operational Requirements: The facility has a current plan of operation and infection control plan on file with the department. The Facility is operating in compliance with the granted fire clearance. The facility has current liability insurance and expires on 05/01/2026. The facility is approved for a capacity of 6 with 6 Non-Ambulatory of which 6 may be bedridden. Hospice approved for 3. Physical Plant & Environment Safety: The facility is a 5 bedroom and 3 bathrooms currently occupying 6 residents and employs 3 full time live in staff, 3 Administrators and 6 back up staffing. LPA was authorized to enter and inspect facility. The facility has smoke and carbon monoxide detectors. The lighting and lamps are sufficient for the use of the facility and for resident comfort. The showers have non-skid mats. Toilet, hand washing and bathing facilities are operational and secured grab bars are present. The pathways are clear of any obstructions. Facility is well lit inside and outside for safety. Disinfectant, cleaning solutions and poisons are inaccessible to residents in care locked in laundry room. The facility has sufficient space inside and outside for activities and visiting. The facility has an fenced backyard for client use with plenty of shade. The gates on the sides of house are self closing and self latching. The facility has telephone and internet service for resident use. Continued 809-C Staffing: The facility employes 3 full time live in staff, 3 Administrators and 6 back up staffing. Staff records are kept confidential. Files reviewed had current 1st Aid/CPR, Personnel Records/Application, Health screening with TB results, Criminal Record statements, and Finger print clearance/Associations/exemptions. Administrator file was reviewed for Continuing Education requirements and current Administrator Certificate. Administrator Certificate expires 01/21/2027. Personnel Records & Training: The facility keeps confidential files for each staff member. Staff have training with 20 plus hours meeting topics to cover for 2024-2025. Residents Rights and Information: All required personal rights are posted. CCL and LTCO Complaint posters are posted. The facility has a posting board on the wall in the entry with all required postings posted. The facility offers telephone and internet service to residents in care. Planned Activities: The facility has a cupboard with puzzles, games, books and TV in rooms and living rooms. Residents walk around pathways in the back yard. There is enough space inside and outside for activities. Residents do the activities they like and want to do. Food Service: The facility handles and prepares food safely. The facility has 2 day perishables and 7 day non-perishables to meet the food service requirement. The freezer is kept at 0 degrees and the refrigeration is kept at 40 degrees or lower. All food is covered, stored and marked appropriately. Food, snacks and drinks are available when the residents want them. Emergency supply of food and water is available. Cleaning solutions and equipment are stored separately from food supplies. Kitchen staff are observed for personal hygiene and food sanitation practices. Incidental Medical and Dental Services: Facility provides or assists in providing transportation to medical and dental appointments when needed. The facility uses the Medication Administration Record (MAR) along with the Centrally Stored Medication and Destruct Records (CSMDR). LPA checked medications for all 6 residents, medication labels were not altered and medications were stored in original containers. Resident Records & Incident Reports: The facility keeps separate files on each resident confidentially. Facility does submit incident reports to the department when required. LPA reviewed 5 resident files for signed Admission Agreements, Personal Rights, Safeguard for property and valuables, LIC. 602A Physicians report, Pre-appraisals, Appraisals Needs and Services Plan, Emergency and ID forms, all forms were legible and completed in separate confidential binder for each resident in care. Continued 809-C Disaster Preparedness: The current emergency disaster forms were posted. The facility conducts quarterly disaster drills. The fire extinguishers was charged and last inspected on 09/30/2025. Emergency exits and telephone numbers were posted. A set of keys is available for staff on all shifts to access full facility in an emergency. Residents with Special Health Needs: The facility does accept dementia residents in care. All items that could pose a danger, sharps, cleaners were locked or in accessible to residents in care. The facility has 2 resident currently on oxygen and signs are posted. The facility has 1 hospice residents in care. Hospice care plans are kept on file and up to date. The facility currently has 3 residents receiving Home Health services. Home Health services records are kept on file. The facility does not have delayed egress. Exit doors have alarms. LPA interviewed 2 staff and 2 residents. Exit interview conducted, copy of report printed for Back up Administrator.the state’s words, verbatim · CDSS document, Oct 2, 2025

Allegation investigated: Medications were accesable to residents in care

Licensing Program Analyst's (LPA's) De Leon and Haner-Tomasko conducted a 10-day Complaint visit to the facility above. LPA met with I. Enos Patacsil Administrator and explained the purpose of the visit. LPA toured kitchen & dining room medication cupboards during the visit the medication cupboards were locked on LPA visit. LPA requested a resident roster and staff roster. On the allegation: Medications were accesiable to residents in care. LPA conducted interview with staff which revealed the Long Term Care Ombusman (LTCO) visited the facility on 02/11/2025 and found a medication cupboard unlocked while a reisdent in care was in the dining room area and the staff left the area to attend to another resident in care. Based on the evidence this allegation is deemed Substaniated at this time. Exit interview conducted, deficnecy cited, copy of report and appeal rights printed for Administrator. Substantiatedthe state’s words, verbatim · CDSS document, Feb 12, 2025 · control 29-AS-20250211110740

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87465(h)(2) · Plan of correction due date: Feb 19, 2025

(h)...(2)Centrally stored medicines shall be kept in a safe and locked place that is not accessible to persons other than employees responsible for the supervision of the centrally stored medication. Based on interview the licensee did not comply with the regulation above medication was unlocked which posess a ptential health, and safety risk to residents in care.the state’s words, verbatim · CDSS document, Feb 12, 2025

Plan of correction: Administrator agreed to train staff in regulation 87465 and RCFE Medication Guide, provide proof of trianing with staff signatures.

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) De Leon arrived at 9:30 am to conducted a 1 year annual visit to the facility above. LPA met with Administrator I. Enos Patacsil and explained the purpose of the visit. A tour of the inside and outside of the facility was conducted with Administrator. The following was inspected and noted during the annual visit: Infection Control: The facility has a current Infection Control Plan. The facility has a sign in and out clipboard for visitors at entry with hand sanitizer. The bathrooms have toilet paper, paper towels, hand soap, and hand washing signs. The facility has EPA approved disinfectants spray and cleaners. The facility has a 30 day supply of PPE. Quarantined or isolated individuals will have meals and medication delivered to rooms. Staff are trained on infection control and the use of Personal Protective Equipment (PPE). All trash cans and waste baskets have covers. Operational Requirements: The facility has a current plan of operation and infection control plan on file with the department. The Facility is operating in compliance with the granted fire clearance. The facility has current liability insurance and expires on 05/01/2025. The facility is approved for a capacity of 6 with 6 Non-Ambulatory of which 6 may be bedridden. Hospice approved for 3. Physical Plant & Environment Safety: The facility is a 5 bedroom and 3 bathrooms currently occupying 4 residents and employs 3 full time live in staff and 2 Administrators. LPA was authorized to enter and inspect facility. The facility has smoke and carbon monoxide detectors. Carbon Monoxide was tested and working at the time of the visit. The lighting and lamps are sufficient for the use of the facility and for resident comfort. The facility kitchen needed additional cleaning around the stove, hood, oven and microwave. The showers have non-skid mats. Toilet, hand washing and bathing facilities are operational and secured grab bars are present. The pathways are clear of any obstructions. Facility is well lit inside and outside for safety. Disinfectant, cleaning solutions and poisons are inaccessible to residents in care locked in laundry room. The facility has sufficient space inside and outside for activities and visiting. The facility has an fenced backyard for client use with plenty of shade. The gates on the sides of house are self closing and self latching. The facility has telephone and internet service for resident use. Continued 809-C Staffing: The facility employes 3 full time live in staff and 2 Administrators. Facility has 18 back up Staff if needed, Staff records are kept confidential. Files reviewed had current 1st Aid/CPR, Personnel Records/Application, Health screening with TB results, Criminal Record statements, and Finger print clearance/Associations/exemptions. Administrator file was reviewed for Continuing Education requirements and current Administrator Certificate. Administrator Certificate expires 01/21/2025. Personnel Records & Training: The facility keeps confidential files for each staff member. Staff have training with 20 plus hours meeting topics to cover for 2024. Residents Rights and Information: All required personal rights are posted. CCL and LTCO Complaint posters are posted. The facility has a posting board on the wall in the entry with all required postings posted. The facility offers telephone and internet service to residents in care. Planned Activities: The facility has a cupboard with puzzles, games, books and TV in rooms and living rooms, Residents walk around pathways in the back yard. There is enough space inside and outside for activities. Residents do what they want and what they like to do. Food Service: The facility handles and prepares food safely. The facility has 2 day perishables and 7 day non-perishables to meet the food service requirement. The freezer is kept at 0 degrees and the refrigeration is kept at 40 degrees or lower. All food is covered, stored and marked appropriately. Food, snacks and drinks are available when the residents want them. Emergency supply of food and water is available. Cleaning solutions and equipment are stored separately from food supplies. Kitchen staff are observed for personal hygiene and food sanitation practices. Incidental Medical and Dental Services: Facility provides or assists in providing transportation to medical and dental appointments when needed. The facility uses the Medication Administration Record (MAR) along with the Centrally Stored Medication and Destruct Records (CSMDR). LPA checked medications for all 4 residents, no medications was expired, medication labels were not altered and medications were stored in original containers. Resident Records & Incident Reports: The facility keeps separate files on each resident confidentially. Facility does submit incident reports to the department when required. LPA reviewed 4 resident files for signed Admission Agreements, Personal Rights, Safeguard for property and valuables, LIC. 602A Physicians report, Pre-appraisals, Appraisals Needs and Services Plan, Emergency and ID forms, all forms were legible and completed in separate confidential binder for each resident in care. Continued 809-C Disaster Preparedness: The current emergency disaster forms were posted. The facility conducts quarterly disaster drills. The fire extinguishers was charged and last inspected on 09/10/2024. Emergency exits and telephone numbers were posted. A set of keys is available for staff on all shifts to access full facility in an emergency. Residents with Special Health Needs: The facility does accept dementia residents in care. All items that could pose a danger, sharps, cleaners were locked or in accessible to residents in care. The facility has 1 resident currently on oxygen and signs are posted. The facility has 1 hospice residents in care. Hospice care plans are kept on file and up to date. The facility currently has 2 residents receiving Home Health services. Home Health services records are kept on file. The facility does not have delayed egress. Exit doors have alarms. Administrator has provided invoices from Pest Control company coming out routinely. LPA interviewed 2 staff and 2 residents. Exit interview conducted, copy of report printed for Administrator.the state’s words, verbatim · CDSS document, Oct 25, 2024

Allegation investigated: Facility staff did not ensure centrally stored medicines were kept locked and inaccessible to residents in care.

Licensing Program Analyst (LPA) Erika Miller conducted an unannounced initial complaint visit to the facility above on 9/17/24 and met with Administrator, Inocencio Patacsil, and explained the purpose of the visit. LPA interviewed staff and residents and toured the facility. On 9/9/24 a Witness observed medication in refrigerator was not locked. On 9/10/24, Witness observed that refrigerated medication remained unlocked, and the daily medication storage area located in the dining room area was also unlocked. On 9/17/24 LPA observed that all medications were locked in cupboard and inaccessible to residents in care. LPA also observed that medication stored in refrigerator was locked in a storage container in refrigerator. Substantiated Administrator acknowledged that medications in cupboard and refrigerator were left unlocked on 9/9/24 and 9/10/24. Administrator stated that he reminded all staff to lock all medications on 9/10/24. Staff 1 acknowledged that they have been reminded that all medications must be locked and inaccessible to residents in care. Based on LPAs observations and interviews which were conducted the preponderance of evidence standard has been met, therefore the above allegation(s) is found to be SUBSTANTIATED. California Code of Regulations are being cited on the attached LIC 9099-D. Exit interview conducted. Report and appeal rights were printed for Administrator.the state’s words, verbatim · CDSS document, Sep 17, 2024 · control 29-AS-20240911115801

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87465(2) · Plan of correction due date: Sep 18, 2024

87465 (2)Incidental Medical and Dental Care. Centrally stored medicines shall be kept in a safe and locked place that is not accessible to persons... This requirement is not met as evidence by: Based on interview, the licensee did not comply with the section cited above when medications were left unlocked and accessible, which posed a potential personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Sep 17, 2024

Plan of correction: Administrator agreed to remind staff to keep medications locked and inaccessible to residents in care by 9/18/24.

Type of visit: Case Management - Annual Continuation

Licensing Program Analyst (LPA) conducted a case management annual continuation of the facility. LPA met with Administrator I Enos Patacsil and explained the purpose of the visit. Resident Records & Incident Reports: The facility keeps separate files on each resident confidentially. Facility does submit incident reports to the department when required. LPA reviewed 5 resident files for signed Admission Agreements, Personal Rights, Safeguard for property and valuables, LIC. 602A Physicians report, Pre-appraisals, Appraisals Needs and Services Plan, Emergency and ID forms, all forms were legible and completed in separate confidential folders for each resident in care. Incidental Medical Services: Facility provides transportation or assist in providing transportation to medical and dental appointments when needed. The facility uses the Medication Administration Record (MAR) along with the Centrally Stored Medication and Destruct Records (CSMDR). LPA reviewed all 5 residents medications, no labels were altered, and no medications were expired. All forms were completed accurately. Administrator and 1 staff person review medications for destruction, complete forms and take to the pharmacy to be destroyed. Exit interview conducted and copy of report printed for Administrator.the state’s words, verbatim · CDSS document, Oct 7, 2023

Type of visit: Required - 1 Year

Licensing Program Analyst (LPA) De Leon arrived at 10:00 am to conducted a 1 year annual visit to the facility above. LPA met with Back up Administrator Crystal Karen Thavaj and explained the purpose of the visit. A tour of the inside and outside of the facility was conducted with Administrator. The following was inspected and noted during the annual visit: Infection Control: The facility has a current Infection Control Plan. The facility has a sign in and out clipboard for visitors at entry with hand sanitizer. The bathrooms have toilet paper, paper towels, hand soap, and hand washing signs. The facility has EPA approved disinfectants spray and cleaners. The facility has a 30 day supply of PPE. Quarantined or isolated individuals will have meals and medication delivered to rooms. Staff are trained on infection control and the use of Personal Protective Equipment (PPE). All trash cans and waste baskets have tight fitting covers. Physical Plant & Environment Safety: The facility is a 5 bedroom and 3 bathrooms currently occupying 5 residents and employs 3 full time live in staff and 2 Administrators. LPA was authorized to enter and inspect facility. The facility has smoke and carbon monoxide detectors. Carbon Monoxide was tested and working at the time of the visit. The lighting and lamps are sufficient for the use of the facility and for resident comfort. The facility kitchen needed additional cleaning around the stove, hood, oven and microwave. The showers have non-skid mats. Toilet, hand washing and bathing facilities are operational and secured grab bars are present. The pathways are clear of any obstructions. Facility is well lit inside and outside for safety. Disinfectant, cleaning solutions and poisons are inaccessible to residents in care locked in laundry room. The facility has sufficient space inside and outside for activities and visiting. The facility has an fenced backyard for client use with plenty of shade. The gates are in need of repair to be self latching due to normal wear and tear. The facility has telephone and internet service for resident use. Continued 809-C Operational Requirements: The facility has a current plan of operation and infection control plan on file with the department. The Facility is operating in compliance with the granted fire clearance. The facility has current liability insurance and expires on 05/01/2024. The facility is approved for a capacity of 6 with 6 Non-Ambulatory of which 6 may be bedridden. Hospice approved for 3. Staffing: The facility employes 3 full time live in staff and 2 Administrators. Facility has 18 back up Staff if needed, Staff records are kept confidential. Files reviewed had current 1st Aid/CPR, Personnel Records/Application, Health screening with TB results, Criminal Record statements, and Finger print clearance/Associations/exemptions. Administrator file was reviewed for Continuing Education requirements and current Administrator Certificate. Administrator Certificate expires 11/15/2023 and 01/25/2023. Personnel Records & Training: The facility keeps confidential files for each staff member. Staff have training for 2023 but are not meeting the full 20 hours required, Administrator will make sure all staff met the 20 hour annual requirement and provide proof of training to LPA. Resident Records & Incident Reports: The facility keeps separate files on each resident confidentially. Facility does submit incident reports to the department when required. LPA will return at a later date to review resident files. Food Service: The facility handles and prepares food safely. The facility has 2 day perishables and 7 day non-perishables to meet the food service requirement. The freezer is kept at 0 degrees and the refrigeration is kept at 40 degrees or lower. All food is covered, stored and marked appropriately. Food, snacks and drinks are available when the residents want them. Emergency supply of food and water is available. Cleaning solutions and equipment are stored separately from food supplies. Kitchen areas needed additional cleaning of grease around the stove area. The facility currently has A-1 Pro coming out to control insect problem, Administrator provided invoice and is having company come out routinely until eradicated. All of the other areas of the kitchen are clean and sanitary. Kitchen staff are observed for personal hygiene and food sanitation practices. Incidental Medical Services: Facility provides transportation to medical and dental appointments when needed. The facility uses the Medication Administration Record (MAR) along with the Centrally Stored Medication and Destruct Records (CSMDR). LPA will return at a later date to review residents medications and records. Disaster Preparedness: The current emergency disaster forms were posted. The facility conducts quarterly disaster drills. The fire extinguishers was charged and last inspected on 08/01/2023. Emergency exits and telephone numbers were posted. A set of keys is available for staff on all shifts to access full facility in an emergency. Residents with Special Health Needs: The facility does accept dementia residents in care. All items that could pose a danger, sharps, cleaners were locked or in accessible to residents in care. The facility does not currently have residents with oxygen. The facility has 2 hospice residents in care. Hospice care plans are kept on file and up to date. The facility currently has 1 residents receiving Home Health services. Home Health services records are kept on file. The facility does not have delayed egress. The facility has two self closing gates and self latching is wearing and latches need to be replaced. Exit door alarm system is currently not working Administrator provided an invoice dated 09/22/2023 for a part on order to fix the issue. LPA will return to conduct interviews with residents and staff. LPA will return at a later date to complete the annual visit. Exit interview conducted, deficiencies cited, copy of report and appeal rights printed for Administratorthe state’s words, verbatim · CDSS document, Oct 4, 2023