405850052-6-28-2024-29-AS-KBUY-D7NNPT-20240730103852

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 405850052
Report Date: 06/28/2024
Date Signed: 06/28/2024 11:02:24 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/16/2023 and conducted by Evaluator Mark Jeffries

COMPLAINT CONTROL NUMBER: 29-AS-20231016094648

FACILITY NAME:	PARK PLACE ASSISTED LIVING		FACILITY NUMBER:	405850052
ADMINISTRATOR:	BARNHILL, DIANA		FACILITY TYPE:	740
ADDRESS:	7500 PORTOLA RD		TELEPHONE:	(805) 591-9855
CITY:	ATASCADERO	STATE: CA	ZIP CODE:	93422
CAPACITY:	13	CENSUS: 12	DATE:	06/28/2024
		UNANNOUNCED	TIME BEGAN:	09:40 AM
MET WITH:	Administrator Diana Barnhill,		TIME COMPLETED:	11:40 AM

ALLEGATION(S):

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Licensee does not ensure an adequate supply of food is maintained and accessible at the facility.
Staff are not adhering to food service requirements.

INVESTIGATION FINDINGS:

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On 06/28/2024, at 10:00am Licensing Program Analyst (LPA) Jeffries arrived unannouced to the facility to deliver final findings to both allegations to this complaint. LPA met with Administrator Diana Barnhill, announced who he is and the reason for the visit.
As to the allegation of, “Licensee does not ensure an adequate supply of food is maintained and
accessible at the facility.” It was alleged that on 09/20/23, and 10/11 and 12/2023 the facility did not have sufficient food for residents and fresh fruit is not available to residents. It was discovered through documentation, grocery receipts, observations and interviews that on 10/23/23, LPA Jeffries conducted interviews of 6 or 12 Residents (R1, 2, 3, etc…) residing at the facility, R1-R6 all stated that they can request food or snacks at any time and have never been denied food or snacks at this facility. Interviews of Staff 1-4 (S1, S2, and S3) on 10/23/23, all stated that they provide residents with snacks twice a day and whenever requested and provide 3 meals per day. All stated that they have never denied any resident food at any time. CONTINUED on LIC9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Kelly Burley	TELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Mark Jeffries	TELEPHONE: (805)562-0400
LICENSING EVALUATOR SIGNATURE:	DATE: 06/27/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/27/2024

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 29-AS-20231016094648

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: PARK PLACE ASSISTED LIVING	FACILITY NUMBER: 405850052
	VISIT DATE: 06/28/2024

NARRATIVE

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All stated that one resident would take one bite of fruit then take another fruit and bite it without finishing fruit, which required fruit to be available upon request. All stated that there is always enough food supply, all 4 staff stated they have been trained in preparing meals for residents. Interview of Administrator on October 23, 2023 stated that the facility always has food, 3 meals a day, two specific snack times and pantry for “on request” snacks, Administrator added that due to confusion, wandering, and sundowning behavior of one Resident, the fresh fruits and all snacks are available for residents on request. Administrator stated at least two staff are on duty at all times to provided resident request. On 10/23/23, LPA Jeffries observed more than 2 days of perishable foods and more than 7 days of non-perishable foods on hand at the facility, LPA took photographs to document food supply. On 10/23/23 LPA Jeffries collected and reviewed facility grocery receipts from September to October 2023. Receipts for grocery items that were delivered to the facility show; on 09/05/23 Costco $197.31, 09/07/23 Costco $156.52, 09/11/23 Food4Less $143.81, 09/12/23 Costco $198.17, 09/14/23 Food4Less $112.26, 09/17/23 Costco $129.80, 09/18/23 Grocery Outlet $118.88, 09/22/23 Costco $163.48, 09/26/23 Vons $215.74, 09/27/23 Food4Less $155.78, 10/03/23 Costco $138.16, 10/04/23 Food4Less $106.09, 10/04/23 Food4Less $101.19, 10/06/23 Costco $164.23, 10/08/23 Food4Less $234.30, 10/10/23 Vons $191.81, 10/10/23 Food4Less $84.90, 10/10/23 Costco $75.03, 10/11/23 Food4Less $85.26, 10/12/23 Costco $343.13, and 10/16/23 Food4Less $209.26. ($3114.03 + $1930.25 = Total of $5044.28 spent in 45-day period) Of the receipts that were not delivery to the facility receipts during this time frame were as follows; 10/17/23 Smart and Final $120.59, 10/17/23 Grocery Outlet $143.43, 10/17/23 Vons $304.28, 10/20/23 Wall Mart $422.50, 10/20/23 Grocery Outlet $292.07, and unverifiable date Costco $647.38. Collectively, all receipts reviewed between the dates of 09/05/23 and 10/20/23 show an average of grocery shopping every 1.7 days at $112.10 per every day for 45 days on average in the time frame from 09/05/23 through 10/20/23. LPA noted that observations on 10/23/23 show crackers, cookies, mini doughnuts, potato chips, and assorted snack foods were stocked in pantry, fresh fruits were on the counter in the kitchen area visible to residents, and ice cream bars, and ice cream were stocked in freezers available to residents upon request. At this time, there is not enough evidence to support the allegation of, “Licensee does not ensure an adequate supply of food is maintained and accessible at the facility.” and is unsubstantiated at this time.

CONTINUED on LIC9099-C

SUPERVISOR'S NAME: Kelly Burley	TELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Mark Jeffries	TELEPHONE: (805)562-0400
LICENSING EVALUATOR SIGNATURE:	DATE: 06/27/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/27/2024

LIC9099 (FAS) - (06/04)

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Control Number 29-AS-20231016094648

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364

FACILITY NAME: PARK PLACE ASSISTED LIVING	FACILITY NUMBER: 405850052
	VISIT DATE: 06/28/2024

NARRATIVE

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As to the allegation of, “Staff are not adhering to food service requirements.” It was alleged that the facility was using unsafe food handling methods regarding cross contamination of meats. It was discovered through observations, documentation, training records, and interviews that on 10/23/23 LPA Jeffries conducted interviews of S1-S3. All 3 staff stated they have been trained in preparing meals for residents. All three staff stated that they had their initial 40 hours of training that included meal preparation. S1-S3 all denied any cross contamination of foods while preparing meals at this facility. On 10/23/2023, LPA Jeffries interviewed R1-R7, who all stated, they like the food at this facility. All stated that they get snacks and 3 cooked meals per day. All stated they have never had an issue with the food service at this facility. On 10/23/2023, LPA Jeffries observed more than 2 days of perishable foods and more than 7 days of non-perishable foods on hand for at least 13 residents and staff. At this time there is not enough evidence to support the allegation of, “Staff are not adhering to food service requirements.” and is unsubstantiated at this time.

Exit interview, report read, and report provided.

SUPERVISOR'S NAME: Kelly Burley	TELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Mark Jeffries	TELEPHONE: (805)562-0400
LICENSING EVALUATOR SIGNATURE:	DATE: 06/27/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/27/2024

LIC9099 (FAS) - (06/04)

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