157206719-2-7-2024-24-AS-SPIY-D2HUNH-20240216144357

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 157206719
Report Date: 02/07/2024
Date Signed: 02/07/2024 02:59:21 PM

Substantiated

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
01/29/2024 and conducted by Evaluator Darius Williams

PUBLIC

COMPLAINT CONTROL NUMBER: 24-AS-20240129153554

FACILITY NAME:	PARK RCFE, THE		FACILITY NUMBER:	157206719
ADMINISTRATOR:	MALONE, CATHY		FACILITY TYPE:	740
ADDRESS:	311 GARNSEY AVENUE		TELEPHONE:	(661) 283-4160
CITY:	BAKERSFIELD	STATE: CA	ZIP CODE:	93309
CAPACITY:	9	CENSUS:	DATE:	02/07/2024
		UNANNOUNCED	TIME BEGAN:	11:09 AM
MET WITH:	Administrator, Cathy Malone		TIME COMPLETED:	12:14 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Facility bathrooms are in disrepair.
Facility bathrooms have mold/rust.
Facility bathrooms are not maintained in a clean condition.

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst (LPA) Darius Williams conducted an unannounced complaint visit. LPA Williams met with Administrator Cathy Malone and discussed the purpose of the visit.

LPA Williams and the Administrator toured three bathrooms.

In Bathroom 1 LPA Williams observed blackening of the tile grout (which the Administrator identified as possible mold) the cupboards had black and yellow marks on it, the tub had extensive black and yellow marks throughout the tub (which the Administrator identified as possible rust and wear and tear), the tub stopper was missing and the actuator for the stopper was broke, and the left sink was missing a handle.

Bathroom 2 is for employees and visitors. LPA observed some bubbling of the paint.

*Continued on LIC 9099C*

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Serigy Pidgirny	TELEPHONE: (559) 246-0610
LICENSING EVALUATOR NAME: Darius Williams	TELEPHONE: 559-243-8080
LICENSING EVALUATOR SIGNATURE:	DATE: 02/07/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/07/2024

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 3

Control Number 24-AS-20240129153554

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: 02/07/2024

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

Bathroom 3 LPA observed the sink stopper and one lightbulb above the sink to be missing.

The Administrator reported she would need some time to address some of the issues.

Administrator agreed to submit a report to the Department identifying the items to be fixed and the timeline.

Plan of correction was reviewed.

An exit interview was conducted and a copy of this report and appeal rights were provided via e-mail.

SUPERVISOR'S NAME: Serigy Pidgirny	TELEPHONE: (559) 246-0610
LICENSING EVALUATOR NAME: Darius Williams	TELEPHONE: 559-243-8080
LICENSING EVALUATOR SIGNATURE:	DATE: 02/07/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/07/2024

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 24-AS-20240129153554

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: 02/07/2024

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 02/09/2024 Section Cited CCR 87303(a)	1 2 3 4 5 6 7	(a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. This requirement was not met evident by:	1 2 3 4 5 6 7	Administrator agreed to submit a report to the Department detailing each item to be addressed and the timeline of completion. Report is due to the Department by POC due date of 2/9/2024.
	8 9 10 11 12 13 14	Based on LPA observation the Licensee did not ensure 2 out of 3 bathrooms were clean and in good repair which poses a potential personal rights violation to persons in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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: Serigy Pidgirny	TELEPHONE: (559) 246-0610
LICENSING EVALUATOR NAME: Darius Williams	TELEPHONE: 559-243-8080
LICENSING EVALUATOR SIGNATURE:	DATE: 02/07/2024

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/07/2024

LIC9099 (FAS) - (06/04)

Page: 3 of 3