486803845-10-1-2021-21-AS-HDBI-C7ZV76-20211021161035

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 486803845
Report Date: 09/30/2021
Date Signed: 10/01/2021 09:26:36 AM

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
06/25/2021 and conducted by Evaluator Karina Canela

PUBLIC

COMPLAINT CONTROL NUMBER: 21-AS-20210625082525

FACILITY NAME:	PARKROSE GARDENS OF FAIRFIELD		FACILITY NUMBER:	486803845
ADMINISTRATOR:	SEABOURNE, JASMINE		FACILITY TYPE:	740
ADDRESS:	1095 EAST TABOR AVENUE		TELEPHONE:	(707) 422-1565
CITY:	FAIRFIELD	STATE: CA	ZIP CODE:	94533
CAPACITY:	102	CENSUS: 36	DATE:	09/30/2021
		UNANNOUNCED	TIME BEGAN:	02:30 PM
MET WITH:	Beverly Murcurio, Health & Wellness Nurse		TIME COMPLETED:	06:00 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Facility staff did not assist resident's with feeding needs

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Licensing Program Analyst (LPA) Karina Canela arrived unannouced to Parkrose Gardens of Fairfield for the purpose of delivering findings on complaint investigation. LPA met with Beverly Murcurio, Health & Wellness Nurse.

During the investigation, LPA made observations, requested and reviewed documents, and conducted interviews with 15 of 19 staff. Complaint alleges “Facility staff did not assist resident's with feeding needs"

Report continued on LIC9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Hope DeBenedetti	TELEPHONE: (707) 588-5059
LICENSING EVALUATOR NAME: Karina Canela	TELEPHONE: 707-588-5054
LICENSING EVALUATOR SIGNATURE:	DATE: 09/30/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/30/2021

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 2

Control Number 21-AS-20210625082525

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: 09/30/2021

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
26
27
28
29
30
31
32

Community Care Licensing (CCL) received a report alleging "Facility staff did not assist resident's with feeding needs". It was alleged Parkrose Gardens of Fairfield caregivers were refusing to feed puree foods to residents.
LPA observed staff assisting feeding residents with solid and puree foods. Interviews conducted indicated staff (caregivers, medtechs, nurses, maintenance staff, and kitchen staff) assist residents with feeding solid and puree foods. 13 of 15 staff interviews indicated staff help each other assisting with resident feeding, assist with puree food feeding, and do not feed too quickly or skip feeding residents. Additionally residents who refuse to eat or are still sleeping during meal time, are provided meal options and staff try again when the resident is awake. 2 of 15 staff interviews revealed caregiver staff (S1) will feed residents too quickly or skip feeding residents their puree foods. Interview with S1 indicated residents sometimes refuse to eat during meal time, S1 does not force feed, but will try again after a few minutes. 13 of 15 staff stated S1 does not feed residents too quickly and does not skip feeding residents.

Due to contradicting statements, as well as all the information gathered, the Department was not able to corroborate the allegation. Although the allegation “Facility staff did not assist resident's with feeding needs" may have occurred or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegations are UNSUBSTANTIATED. We have therefore dismissed this 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

Due to printer malfunction, this report was emailed to the facility.

SUPERVISOR'S NAME: Hope DeBenedetti	TELEPHONE: (707) 588-5059
LICENSING EVALUATOR NAME: Karina Canela	TELEPHONE: 707-588-5054
LICENSING EVALUATOR SIGNATURE:	DATE: 09/30/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/30/2021

LIC9099 (FAS) - (06/04)

Page: 2 of 2