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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 486803845
Report Date: 09/19/2020
Date Signed: 09/19/2020 02:12:50 PM

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: 46DATE:
09/19/2020
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Marlene, BremerTIME COMPLETED:
11:30 AM
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Licensing Program Analyst (LPA) K. Canela contacted Parkrose Gardens of Fairfield to observe weekend operations regarding COVID-19. LPA conducted a facility visit through virtual calling; due to COVID-19 precautions a facility in-person visit was not able to be conducted at this time. LPA met with Administrator, Marlene Bremer by virtual calling.
Administrator conducted the virtual tour through the facility. LPA observed front entrance with sanitation station set up. Staff and essential visitors are asked to sanitize their hands, screened for symptoms, have their temperature taken and logged. The facility logs temperatures and screening questions in two separate binders, one for staff and one for essential visitors. Staff were observed wearing Personal Protective Equipment such as masks, face shields, disposable gloves and gowns.
Currently, COVID-19 positive residents are isolated separately from residents who have tested negative for COVID-19. Positive residents are isolated on the second floor and negative residents reside on the first floor. There are 3 caregivers and 1 med-tech (during AM and PM shift) and 2 caregivers and 1 med-tech (during NOC shift) designated to care for residents on the second floor. There are 2 caregivers and 1 med-tech designated (during AM, PM and NOC shift) to care for residents on first floor.
Food for residents is prepared at the facility and plated into disposable containers. The food containers are put into a metal box food tray that is wheeled into the elevator. Staff from second floor distributes the food to residents, disinfects the metal box food tray and sends it back down the elevator. There are 3 residents which require assistance with feeding. All garbage, including used PPE, are put into garbage bags, tied with a tight knot, and brought out through the second-floor stairwell leading outside. Second floor staff exit the facility through the outside stairwell after their shift. Administrator stated staff disinfect and clean every hour, which includes doorknobs, handrails, tables, chairs, and commonly touched surfaces.

Administrator stated resident's family members can schedule a virtual visit with the resident once a week.
LPA will review information and requested facility to notify LPA if family of residents request additional time for a virtual meeting and how facility will accommodate their request.

Report continued on LIC 809C
SUPERVISOR'S NAME: Carla MartinezTELEPHONE: (707) 588-5079
LICENSING EVALUATOR NAME: Karina CanelaTELEPHONE: (707) 588-5083
LICENSING EVALUATOR SIGNATURE:

DATE: 09/19/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/19/2020
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION 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: PARKROSE GARDENS OF FAIRFIELD
FACILITY NUMBER: 486803845
VISIT DATE: 09/19/2020
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LPA is requesting the following from Administrator to be submitted by 9/23/2020 to LPA K. Canela:
  • Completed LIC9020 - Register of Facility Residents
      • - including contact information for resident's responsible party or family member.
  • Detailed written plan of how the facility, specifically the 3 caregivers and 1 med-tech are meeting the needs of the COVID-19 positive residents.
      • - Per Resident:
      Shower schedule, assistance with feeding, assistance with Activities of Daily Living (ADL), if they are two person assist, how often sheets are changed, and their room is disinfected and cleaned.
  • Detailed plan to ensure staffing for care of COVID-19 positive residents and negative residents
      • - include hiring plan
  • Detailed plan of daily Activities provided for COVID-19 positive residents and negative residents
  • Detailed plan for resident's family virtual visits

    • - include how facility is assisting residents with virtual calls, scheduling visits with family, and plan for hospice resident visitation.


LPA previously provided Home Care Organization list to Administrator for staffing needs. Rohnert Park Regional Office has provided PPE supplies to facility. LPA will continue monitoring facility with daily check in calls for updates and weekly virtual calls.


No deficiencies cited during this visit.
SUPERVISOR'S NAME: Carla MartinezTELEPHONE: (707) 588-5079
LICENSING EVALUATOR NAME: Karina CanelaTELEPHONE: (707) 588-5083
LICENSING EVALUATOR SIGNATURE:

DATE: 09/19/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/19/2020
LIC809 (FAS) - (06/04)
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