405850052-7-22-2024-29-AS-KBUY-DACP63-20241024110133

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 405850052
Report Date: 07/22/2024
Date Signed: 07/22/2024 03:04:00 PM

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
07/15/2024 and conducted by Evaluator Rachael De Leon

COMPLAINT CONTROL NUMBER: 29-AS-20240715084408

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:	07/22/2024
		UNANNOUNCED	TIME BEGAN:	10:15 AM
MET WITH:	Diana Barnhill, Administrator		TIME COMPLETED:	03:15 PM

ALLEGATION(S):

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Staff did not provide adequate food service
Staff did not provide a comfortable temperature for residents

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) De Leon conducted a 10-day complaint visit to the facility above. LPA met with Diana Barnhill Administrator/Licensee and explained the purpose of the visit.

LPA requested the following documentation: Staff Roster with telephone numbers, Staff Schedule for 07/2024, Resident Roster, a new and an old copy of Resident 1 (R1) LIC 602A Physicians report, 5 weeks of resident food menus, and any residents special diets.
Administrator provided all records except no residents are currently on any physican precribed special diet.

LPA toured the facility kitchen, food supply in refrigerator/freezer, food pantry, additonal food stored in basement refirgerators, 3 resident rooms and the secured courtyard.
LPA conducted interviews with staff at 11:15am, 11:35am, 12:20pm and 12:27pm. LPA conducted interviews with residents at 12:45pm, 1:00pm, and 1:10pm.
Continued 9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Kelly Burley	TELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Rachael De Leon	TELEPHONE: (805) 450-0262
LICENSING EVALUATOR SIGNATURE:	DATE: 07/22/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2024

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-20240715084408

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: 07/22/2024

NARRATIVE

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On the allegation: Staff did not provide adequate food service. LPA toured the kitchen, pantry and additional food it the basement refrigerators. LPA observed staff serve lunch to residents in the dining room, the residents were eating and ate what was provided on the plates. The meal served today was a sandwich, chips, pickles, and Jell-O with fruit punch and water, which meets requirements and the supply of food meets the regulation requirements of two day perishables and seven day non-perishable. LPA interviewed staff and residents which revealed the facility provides 3 meals per day, 2 snacks, and dessert. Interviews reveal food, beverages and snacks are available when the residents want them. Resident interviews revealed the food is not great but it is not bad either, would say it is ok. Resident interviews revealed resident would like to have a residents choice on the menu and the menu should be changed up so it is not repeated as often. LPA reviewed the residents menus and the food being served differs from day to day. Resident interviews stated they would prefer more options of bread being offered. Administrator stated the facility will provide food the residents like, and if residents tell the staff/Administrator what they want or need the facility will look into it so they can supply it. Residents interviews revealed the portion size of meals and meals themselves are adequate. Based on the evidence this allegation is Unsubstantiated at this time.

On the allegation: Staff did not provide a comfortable temperature for residents. LPA toured the facility, each resident room has its own air-conditioning unit. Resident interviews revealed the facility is not cold or hot, the temperature is fine and can be adjusted if needed. The staff interviews revealed the facility air-conditioning units are working properly and can be changed as needed if and when the resident wants it. LPA observed on visit the facility outside temperature was at 86 degrees, a warm day and the facility temperature was very comfortable not hot or cold inside. Based on the evidence this allegation is deemed Unsubstantiated at this time.

Exit interview conducted and copy of report printed for Administrator/Licensee.

SUPERVISOR'S NAME: Kelly Burley	TELEPHONE: (805) 562-0413
LICENSING EVALUATOR NAME: Rachael De Leon	TELEPHONE: (805) 450-0262
LICENSING EVALUATOR SIGNATURE:	DATE: 07/22/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/22/2024

LIC9099 (FAS) - (06/04)

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