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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 486803845
Report Date: 08/24/2020
Date Signed: 08/26/2020 09:59:53 AM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT
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:PARKROSE GARDENS OF FAIRFIELDFACILITY NUMBER:
486803845
ADMINISTRATOR:BREMER, MARLENEFACILITY TYPE:
740
ADDRESS:1095 EAST TABOR AVENUETELEPHONE:
(707) 422-1565
CITY:FAIRFIELDSTATE: CAZIP CODE:
94533
CAPACITY:102CENSUS: 48DATE:
08/24/2020
TYPE OF VISIT:Post LicensingUNANNOUNCEDTIME BEGAN:
02:55 PM
MET WITH:Marlene Bremer, Administrator TIME COMPLETED:
05:00 PM
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
Licensing Program Analyst (LPA) K. Canela conducted a Post Licensing inspection at Parkrose Gardens of Fairfield via video conferencing, due to COVID-19 precautions a facility visit is not able to be conducted at this time. LPA met with Administrator, Marlene Bremer.
Administrator conducted a walk through via video conferencing and LPA observed resident rooms were furnished per regulations. Facility has required postings, including but not limited to, the CCL Complaint Poster, Resident Bill of Rights and Resident Rights to Resident Councils. LPA observed posters regarding proper hand washing, droplet precautions and sanitation pertaining to COVID-19. LPA discussed with Administrator to make sure their sanitation station is set-up at front entrance at all times to comply with COVID-19 precautions. Administrator stated she understood and reminded front entrance staff as well. LPA observed staff wearing masks as a COVID-19 precaution. Facility has at least two days of perishable and one week of nonperishable foods. Facility has space indoors and outdoors for resident activities. Currently, residents have activities indoors due to wildfire smoke in the area. Administrator stated disinfectants/toxins are locked in a closet and inaccessible to residents in care. Extra linens and paper supplies are available for residents. Medications are kept locked in medication room and Administrator stated med-techs are properly documenting resident medication logs as well as a Centrally Stored Medication Log is maintained.
LPA observed fire extinguishers (3) in first floor and (4) in the second floor of facility, which were charged and serviced 6/22/2020. Smoke detectors are hardwired and were tested during inspection. LPA observed smoke detectors and carbon monoxide detector were in working order. LPA observed grab bars in resident rooms and common shower room on second floor. LPA discussed with Administrator non-slip mats in all showers/bathtubs for resident’s safety. Administrator stated she would put a non-slip mat in common shower room on second floor. LPA observed all walkways and exits to be unobstructed.
LPA was unable to conduct a thorough review of records due to video conferencing. Facility to ensure new admission agreements following the Change of Ownership under new license number are updated and maintained. Administrator stated staff and resident records/files are current and will be maintained.

LPA and Administrator discussed the importance of the following:
Ensuring all facility staff are trained on how and when to use stairwell evacuation chairs for residents.
Ensuring staff are trained and are using beepers for facility signal system to notify them when a resident pushes the help buttons and in which resident room.
Ensuring staff are trained and participate in facility Disaster Drills every 3 months per regulation. Administrator stated she would send a copy of most recent drill to LPA. *Facility to submit staff's proof of annual training including stairwell evacuation chairs & signal system training and copy of First Aid/CPR certificates to LPA.

No deficiencies cited at today's inspection.
** Signatures in File
SUPERVISOR'S NAME: Carla MartinezTELEPHONE: (707) 588-5079
LICENSING EVALUATOR NAME: Karina CanelaTELEPHONE: (707) 588-5083
LICENSING EVALUATOR SIGNATURE:

DATE: 08/24/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/24/2020
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
Page: 1 of 1