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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 486803845
Report Date: 08/13/2021
Date Signed: 08/13/2021 04:07:19 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
04/15/2021 and conducted by Evaluator Karina Canela
PUBLIC
COMPLAINT CONTROL NUMBER: 21-AS-20210415144055
FACILITY NAME:PARKROSE GARDENS OF FAIRFIELDFACILITY NUMBER:
486803845
ADMINISTRATOR:SEABOURNE, JASMINEFACILITY TYPE:
740
ADDRESS:1095 EAST TABOR AVENUETELEPHONE:
(707) 422-1565
CITY:FAIRFIELDSTATE: CAZIP CODE:
94533
CAPACITY:102CENSUS: 37DATE:
08/13/2021
UNANNOUNCEDTIME BEGAN:
09:40 AM
MET WITH:Beverly Murcurio, Health & Wellness NurseTIME COMPLETED:
03:30 PM
ALLEGATION(S):
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Staff leave residents in wet clothing for extended periods of time

Residents are not being fed adequately

Staff member uses inappropriate form of punishment

Staff failed to meet the residents' needs
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Karina Canela arrived at Parkrose Gardens of Fairfield on 08/13/2021 for the purpose of delivering findings on complaint # 21-AS-20210415144055. LPA met with Beverly Murcurio, Health & Wellness Nurse.

LPA investigated the allegations of “staff leave residents in wet clothing for extended periods of time”, "residents are not being fed adequately", "staff member uses inappropriate form of punishment" and “staff failed to meet the residents' needs”. During the investigation, LPA conducted interviews with 9 of 20 staff, reviewed the facility file, inspected the facility, obtained and reviewed records. Due to resident's mental capacity LPA was not able to receive resident statements.

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: 08/13/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2021
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-20210415144055
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: 08/13/2021
NARRATIVE
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The following was reported to Community Care Licensing (CCL): Parkrose Gardens of Fairfield staff leave residents in wet clothing (urinated clothing and adult briefs) for an extended period of hours. Staff do not change a resident after urinating; residents are only changed after a bowel movement. Sometimes staff will not change the residents for a long time unless a large puddle of urine is observed under a resident's wheelchair. It was also alleged that staff do not feed residents properly as staff (S1) will skip feeding residents who eat slowly and will throw away their food. It was alleged staff (S2) will dig their nails into Resident (R1)'s hands as a form of punishment.

S1 stated they regularly check on residents every 30 minutes for toileting and has never witnessed a resident left soiled for a long period of time. S1 denied the allegation, assists residents with feeding, and has not witnessed other staff not assisting residents with feeding. S1 stated all staff will assist with feeding, as they are a team. S2 stated they have never hurt or have been rough with a resident. S1 & S2 stated concerns are reported to the med-tech on duty and/or the Health & Wellness Nurse, who then will notify the Executive Director. Staff stated management will taken action if there were any concerns.

Additional staff interviews did not corroborate the allegations.
Staff stated the following information: they work as a team to assist with feeding and toileting residents. Residents may sometimes refuse to eat, however staff will offer another food option such as a sandwich or extra snacks, staff will notify the med-tech or on-duty nurse and try again later. Residents have the right to refuse to eat, but staff will provide options, additional snacks, or offer the food at a later time. Staff check on residents often, at least every 2 hours, for assistance with toileting. Staff have not observed staff or S2 hurting or being rough with residents. Staff would report suspected abuse to the Med-Tech, Health & Wellness Nurse, or Executive Director.

During facility inspections, LPA did not observe wet/soiled residents. LPA observed staff feeding residents and providing assistance. When a resident was not eating, LPA observed staff offering other food options.

Due to the contradicting statements received and lack of witnesses to the incident alleged, as well as all the information gathered, The Department was not able to corroborate the allegations. LPA investigated the complaint alleging “staff leave residents in wet clothing for extended periods of time”, "residents are not being fed adequately", "staff member uses inappropriate form of punishment" and “staff failed to meet the residents' needs”. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED. We have therefore dismissed the complaint. An exit interview was conducted with Beverly Murcurio, Health & Wellness Nurse, whose signature on this form confirms receipt of these documents.

No deficiencies cited during today’s visit regarding the complaint.

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

DATE: 08/13/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/13/2021
LIC9099 (FAS) - (06/04)
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