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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 486803845
Report Date: 05/04/2021
Date Signed: 05/04/2021 04:57:12 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
02/11/2021 and conducted by Evaluator Karina Canela
PUBLIC
COMPLAINT CONTROL NUMBER: 21-AS-20210211155615
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: 36DATE:
05/04/2021
UNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Jasmine Seaborne, AdministratorTIME COMPLETED:
02:30 PM
ALLEGATION(S):
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Memory care resident have locking mechanism on bedroom door they are unable to unlock

Staff not following COVID-19 precautions
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) K. Canela contacted Jasmine Seaborne, Administrator at Parkrose Gardens of Fairfield, on 05/04/2021 by phone for the purpose of delivering findings on complaint # 21-AS-20210211155615. Due to COVID – 19 precautions a facility visit is not able to be conducted at this time.

During the investigation, LPA made observations, requested and reviewed documents, and conducted interviews with 10 of 19 staff and 3 of 36 residents. Complaint alleges “Memory care resident have locking mechanism on bedroom door they are unable to unlock” and “Staff not following COVID-19 precautions”.

Report continued on LIC9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Hope DeBenedettiTELEPHONE: (707) 588-5059
LICENSING EVALUATOR NAME: Karina CanelaTELEPHONE: 707-588-5054
LICENSING EVALUATOR SIGNATURE:

DATE: 05/04/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/04/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 3
Control Number 21-AS-20210211155615
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: PARKROSE GARDENS OF FAIRFIELD
FACILITY NUMBER: 486803845
VISIT DATE: 05/04/2021
NARRATIVE
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Regarding allegation “Memory care resident have locking mechanism on bedroom door they are unable to unlock”:
It was alleged memory care residents were kept behind locked bedroom doors, due to facility staff being asked to unlock a resident’s bedroom door. LPA conducted an unannounced in-person facility inspection on 02/23/2021 for the purpose of opening the complaint and touring the facility, see report dated 02/23/2021. During the in-person facility visit, LPA observed and inspected all 48 resident bedrooms in both the first and second floors of the building. LPA observed there were 22 shared bedroom doors with doorknobs that do not require a key to enter. These doors can be locked and unlocked from the inside using a person’s thumb and index finger to turn the lock (thumb-turn lock) and can be unlocked from the outside by using a thumb fingernail to turn the lock. The 22 shared bedrooms, occupied by residents, were observed to be unlocked during the inspection. LPA observed there were 10 occupied private bedrooms, and 3 residents occupying the private rooms have a doorknob which required a key to unlock from the outside.
The 3 bedroom doors with doorknobs which require a key to lock/unlock the bedroom door from the outside can be unlocked from the inside with a thumb-turn lock (not a key). LPA observed residents (R1, R2, R3), with key lock doorknobs, in which a personal key is used to unlock their bedroom door from the outside. All 3 residents stated they were able to use their key and had their key available to open the door. R1 & R2 were observed demonstrating unlocking/locking their bedroom door from the inside and outside of the their bedroom during inspection. Based on the LIC 602 (Physician's Report) for R1 & R2, they are able to follow instructions. Administrator stated staff test R1 & R2 weekly on locking/locking their bedroom door. R3 was observed laying in their bed resting and stated they prefer their bedroom door to be locked when LPA and Staff (S2) exited the room. R3 was not able to demonstrate locking and unlocking their bedroom door from the inside or outside due to LPA not wanting to disrupt R3 from resting in their bed. Administrator stated staff have a master key to resident bedroom doors with key locks and are able to unlock the door in case of an emergency or for providing care to residents. Additionally, staff interviews indicated staff do not lock resident bedroom doors.
Administrator explained that although resident's bedroom doors are never locked, the facility has removed the thumb-turn lock doorknobs and replaced with doorknobs which do not have locking mechanism (doorknobs replaced on 03/02/2021). R3 uses a walker, wheelchair, and requires assistance with all transfers in and out of bed (per R3's LIC625 - Appraisal/Needs & Service Plan). Administrator stated R3's doorknob (requiring a key) was removed and replaced with a doorknob without a locking mechanism on 03/02/2021.
Report continued on LIC9099-C
SUPERVISOR'S NAME: Hope DeBenedettiTELEPHONE: (707) 588-5059
LICENSING EVALUATOR NAME: Karina CanelaTELEPHONE: 707-588-5054
LICENSING EVALUATOR SIGNATURE:

DATE: 05/04/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/04/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 21-AS-20210211155615
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: PARKROSE GARDENS OF FAIRFIELD
FACILITY NUMBER: 486803845
VISIT DATE: 05/04/2021
NARRATIVE
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Regarding allegation “Staff not following COVID-19 precautions”:
It was reported the facility displayed old isolation notices (from year 2020) and did not have proper COVID-19 precaution signs on some doors. During virtual visit conducted on 02/02/2021 and in-person facility visit conducted on 02/23/2021, LPA did not observe any old COVID isolation notices posted. Administrator stated the isolation notices were previously removed. S2 stated there were a “few isolation notices from last year in the COVID-wing” (second floor of the building). The postings/notices instructed anyone coming into the isolation room (for a COVID-19 positive resident) to put on new Protective Personal Equipment (PPE) when entering and again when exiting the room. S2 stated the facility had the postings/notices displayed as a helpful reminder for the staff. Additionally, it was reported Parkrose had a COVID-19 positive resident (name not provided) in a bedroom without a sign or cart for donning and doffing PPE. It was reported staff were observed entering and exiting the COVID-19 positive resident’s room without donning or doffing PPE. LPA was not provided additional information to identify resident. Staff interviews conducted did not support the allegation as staff stated they follow COVID-19 precautions and isolation protocols.


Due to contradicting statements, as well as all the information gathered, the Department was not able to corroborate the allegations. Although the allegations “memory care resident have locking mechanism on bedroom door they are unable to unlock” and “staff not following COVID-19 precautions” may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED. An exit interview was conducted with Jasmine Seaborne, Administrator, whose signature on this form confirms receipt of these documents.


Signatures in file
SUPERVISOR'S NAME: Hope DeBenedettiTELEPHONE: (707) 588-5059
LICENSING EVALUATOR NAME: Karina CanelaTELEPHONE: 707-588-5054
LICENSING EVALUATOR SIGNATURE:

DATE: 05/04/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/04/2021
LIC9099 (FAS) - (06/04)
Page: 3 of 3