480110389-1-19-2021-21-AS-BMOS-BYAS4W-20210216123322

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 480110389
Report Date: 01/15/2021
Date Signed: 01/19/2021 03:54:50 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928

This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/15/2020 and conducted by Evaluator Araceli Canela

PUBLIC

COMPLAINT CONTROL NUMBER: 21-AS-20201015083014

FACILITY NAME:	PARKSIDE MANOR		FACILITY NUMBER:	480110389
ADMINISTRATOR:	GANZON, CECILIA		FACILITY TYPE:	740
ADDRESS:	50 CADLONI LANE		TELEPHONE:	(707) 557-8991
CITY:	VALLEJO	STATE: CA	ZIP CODE:	94591
CAPACITY:	17	CENSUS: 15	DATE:	01/15/2021
		UNANNOUNCED	TIME BEGAN:	03:25 PM
MET WITH:	Cecilia Ganzon		TIME COMPLETED:	04:00 PM

ALLEGATION(S):

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Facility improperly disposing of syringes

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) A. Canela contacted Parkside Manor by phone and spoke with licensee, Cecilia Ganzon, on 1/15/2021 for the purpose of delivering findings on complaint # 21-AS-20201015083014. Due to COVID – 19 precautions a facility visit is not able to be conducted at this time.

LPA took statements and reviewed records. It was alleged the facility is improperly disposing of syringes. It was reported to CCL, that syringes were observed on the public sidewalk, where facility and neighborhood members place their garbage cans to later be picked up by the local garbage agency. Facility denies allegation and states they do not have or accept any residents that are insulin dependent. Facility states, there are 2 residents that take oral medication and do not require insulin. They do not have a box to dispose of syringes, as they do not handle syringes.
Continue report see LIC9099-C

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Bethany Moellers	TELEPHONE: (707) 588-5026
LICENSING EVALUATOR NAME: Araceli Canela	TELEPHONE: (707) 588-5041
LICENSING EVALUATOR SIGNATURE:	DATE: 01/15/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/15/2021

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 21-AS-20201015083014

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 101 GOLF COURSE DR. STE. A-230
ROHNERT PARK, CA 94928

FACILITY NAME: PARKSIDE MANOR	FACILITY NUMBER: 480110389
	VISIT DATE: 01/15/2021

NARRATIVE

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Licensee S1 states, those syringes found outside on the side walk or street, may belong to other neighbors in the community as they do not take any residents who are insulin dependent in this facility.

The Department has investigated the allegation for Facility improperly disposing of syringes and determined this complaint as unfounded, meaning that the allegation was false, could not have happened and/or is without a reasonable basis.
This report was emailed to facility to obtain signature.

No citations issued.

SUPERVISOR'S NAME: Bethany Moellers	TELEPHONE: (707) 588-5026
LICENSING EVALUATOR NAME: Araceli Canela	TELEPHONE: (707) 588-5041
LICENSING EVALUATOR SIGNATURE:	DATE: 01/15/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/15/2021

LIC9099 (FAS) - (06/04)

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