<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 157206719
Report Date: 08/12/2021
Date Signed: 08/12/2021 03:33:32 PM



STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1314 E SHAW AVE
FRESNO, CA 93710
This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/19/2020 and conducted by Evaluator Malia Thao
PUBLIC
COMPLAINT CONTROL NUMBER: 24-AS-20200819163141
FACILITY NAME:PARK RCFE, THEFACILITY NUMBER:
157206719
ADMINISTRATOR:MALONE, CATHYFACILITY TYPE:
740
ADDRESS:311 GARNSEY AVENUETELEPHONE:
(661) 283-4160
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93309
CAPACITY:9CENSUS: 8DATE:
08/12/2021
UNANNOUNCEDTIME BEGAN:
08:40 AM
MET WITH:Cathy Malone, Licensee/AdministratorTIME COMPLETED:
10:25 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff are mismanaging residents medication.
Staff allowed resident to wander away from the facility.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 8/12/21 at 8:40 AM, Licensing Program Analyst (LPA) Malia Thao arrived unannounced to deliver findings. Licensee (LIC) Cathy Malone was not available to come to the facility, but was available via telephone.

During the investigation, S1 admitted S1 and other staff gave PRN Quetiapine Fumarate to R1 routinely. S1 admitted S1 was not aware S1 needed to ask R1, or to notify R1’s physician prior to each dose. LIC admitted administration of PRN was given based on R1's behavior and did not first consult with physician prior to each dose.
Licensee and S1 admitted and confirmed R1 wandered away from the facility. S1 confirmed S1 was only staff on duty. S2 admitted on two occasions, S2 had to sit and guard the front door for around 30 minutes to prevent R1 from leaving the facility. S2 stated S2 was only staff on duty, thus, leaving all other residents unsupervised. R1's physician report states R1 is diagnosed with dementia, has wandering behavior, and is not able to leave the facility unassisted.
Continue on 9099-C.
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Andy XiongTELEPHONE: (559) 650-7904
LICENSING EVALUATOR NAME: Malia ThaoTELEPHONE: (559) 650-7931
LICENSING EVALUATOR SIGNATURE:

DATE: 08/12/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/12/2021
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 4
Control Number 24-AS-20200819163141
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME: PARK RCFE, THE
FACILITY NUMBER: 157206719
VISIT DATE: 08/12/2021
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
Continued from LIC9909.

The above allegations are substantiated.

Deficiencies are being cited based on LPA observation, interviews conducted, and record review in accordance with the California Code of Regulations, Title 22, see LIC9909D.

An exit interview was conducted via telephone and Plans of Corrections were reviewed and developed with the Licensee. A copy of this report and appeal rights were discussed and emailed to Licensee Cathy Malone at cathyamalone@gmail.com. Email sent with read receipt to confirm receipt of this report.
SUPERVISOR'S NAME: Andy XiongTELEPHONE: (559) 650-7904
LICENSING EVALUATOR NAME: Malia ThaoTELEPHONE: (559) 650-7931
LICENSING EVALUATOR SIGNATURE:

DATE: 08/12/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/12/2021
LIC9099 (FAS) - (06/04)
Page: 4 of 4
Control Number 24-AS-20200819163141
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1314 E SHAW AVE
FRESNO, CA 93710

FACILITY NAME: PARK RCFE, THE
FACILITY NUMBER: 157206719
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/12/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
08/13/2021
Section Cited
CCR
87465(d)
1
2
3
4
5
6
7
87465 Incidental Medical and Dental Care
(d) If the resident is unable to determine his/her own need for a prescription or nonprescription PRN medication, and is unable to communicate his/her symptoms clearly,...permitted to assist the resident with self-administration provided all of the following requirements are met:…

This requirement is not met as evidenced by:
1
2
3
4
5
6
7
Licensee will submit proof of in-service training roster for all staff covering regulation section 87465 to CCL by POC due date. LPA emailed copy of regulation section to Licensee with this report.
8
9
10
11
12
13
14
S1 admitted S1 and other staff gave PRN Quetiapine Fumarate to R1 routinely. S1 admitted S1 was not aware S1 needed to ask R1, or to notify R1’s physician prior to each dose. LIC admitted administration of PRN was given based on R1's behavior and did not first consult with physician prior to each dose. This poses an immediate health, safety, and personal rights risk to residents in care.
8
9
10
11
12
13
14
Type A
08/13/2021
Section Cited
CCR
87705(c)(4)
1
2
3
4
5
6
7
87705 Care of Persons with Dementia (c) Licensees who accept and retain residents with dementia shall be responsible for ensuring the following: (4) There is an adequate number of direct care staff to support each resident’s physical, social, emotional, safety and health care needs...

This requirement is not met as evidenced by:
1
2
3
4
5
6
7
Licensee will submit a tentative schedule to include additional staffing during peak hours of the day to CCL by POC due date, until additional staff can be hired.
8
9
10
11
12
13
14
Licensee and S1 admitted and confirmed R1 wandered away from the facility. S1 confirmed S1 was only staff on duty. S2 admitted on two occasions, S2 had to sit and guard the front door for around 30 minutes to prevent R1 from leaving the facility. S2 stated S2 was only staff on duty, thus, leaving all other residents unsupervised. R1's physician report states R1 is diagnosed with dementia, has wandering behavior, and is not able to leave the facility unassisted. This poses an immediate health, safety, and personal rights risk to residents in care.
8
9
10
11
12
13
14
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Andy XiongTELEPHONE: (559) 650-7904
LICENSING EVALUATOR NAME: Malia ThaoTELEPHONE: (559) 650-7931
LICENSING EVALUATOR SIGNATURE:

DATE: 08/12/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/12/2021
LIC9099 (FAS) - (06/04)
Page: 3 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1314 E SHAW AVE
FRESNO, CA 93710
This is an official report of an unannounced visit/investigation of a complaint received in our office on
08/19/2020 and conducted by Evaluator Malia Thao
PUBLIC
COMPLAINT CONTROL NUMBER: 24-AS-20200819163141

FACILITY NAME:PARK RCFE, THEFACILITY NUMBER:
157206719
ADMINISTRATOR:MALONE, CATHYFACILITY TYPE:
740
ADDRESS:311 GARNSEY AVENUETELEPHONE:
(661) 283-4160
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93309
CAPACITY:9CENSUS: 8DATE:
08/12/2021
UNANNOUNCEDTIME BEGAN:
08:40 AM
MET WITH:Cathy Malone, Licensee/AdministratorTIME COMPLETED:
10:25 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Unlawful eviction.
Staff did not treat resident with dignity and respect.
Staff did not safeguard resident personal belongings.
Resident fell while in care.
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
On 8/12/21 at 8:40 AM, Licensing Program Analyst (LPA) Malia Thao arrived unannounced to deliver findings. Licensee (LIC) Cathy Malone was not available to come to the facility, but was available via telephone.

During the course of the investigation, LPA conducted interviews and reviewed records. Based on observations, interviews, and records review, there was insufficient evidence that an unlawful eviction occurred, that staff did not treat resident with dignity and respect, staff did not safeguard resident personal belongings, and that a resident fell while in care.

The allegations may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violations occurred. The above allegations are unsubstantiated.

Exit interview conducted via telephone. A copy of this report will be emailed to Licensee Cathy Malone at cathyamalone@gmail.com. Email sent with read receipt to confirm receipt of this report.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Andy XiongTELEPHONE: (559) 650-7904
LICENSING EVALUATOR NAME: Malia ThaoTELEPHONE: (559) 650-7931
LICENSING EVALUATOR SIGNATURE:

DATE: 08/12/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/12/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 4