486803946-5-18-2023-21-AS-HDBI-CSMNGV-20230609102742

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 486803946
Report Date: 05/18/2023
Date Signed: 05/18/2023 03:16:15 PM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

This is an official report of an unannounced visit/investigation of a complaint received in our office on
02/09/2023 and conducted by Evaluator Araceli Canela

PUBLIC

COMPLAINT CONTROL NUMBER: 21-AS-20230209132049

FACILITY NAME:	PARKSIDE MANOR		FACILITY NUMBER:	486803946
ADMINISTRATOR:	GANZON, CECILIA		FACILITY TYPE:	740
ADDRESS:	50 CADLONI LN		TELEPHONE:	(707) 246-2754
CITY:	VALLEJO	STATE: CA	ZIP CODE:	94591
CAPACITY:	17	CENSUS: 14	DATE:	05/18/2023
		UNANNOUNCED	TIME BEGAN:	12:16 PM
MET WITH:	Aurelia Renta, licensee		TIME COMPLETED:	01:47 PM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

personal rights

INVESTIGATION FINDINGS:

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

Licensing Program Analyst (LPA), Araceli Canela arrived unannounced for the purposes of getting additional statements and delivering findings to the above investigation for complaint number 21-AS-20230209132049. LPA met with Aurelia Renta, licensee toured the facility and made observations.

It was alleged a residents personal rights were violated, more specifically, that resident (R1) made a comment to an outside individual that they did not want to return to the facility as they were afraid to get beat up. LPA made prior visits, interviewed staff and residents and no one corroborated the allegation. Staff interviewed disclosed they do not yell or put their hands on any residents and denied the allegation. Residents who were able to be interviewed expressed they like living at the home and they are treated well. LPA received an additional statement from an outside individual who expressed they have always seen the staff to be professional and assisting residents and they never heard a complaint or allegation regarding this nature.

Continue report see LIC9099-C

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Kimberley Mota	TELEPHONE: (707) 588-5051
LICENSING EVALUATOR NAME: Araceli Canela	TELEPHONE: (707) 588-5041
LICENSING EVALUATOR SIGNATURE:	DATE: 05/18/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/18/2023

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-20230209132049

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1450 NEOTOMAS AVENUE, STE. 100
SANTA ROSA, CA 95405

FACILITY NAME: PARKSIDE MANOR	FACILITY NUMBER: 486803946
	VISIT DATE: 05/18/2023

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

It was also stated, they have been at the facility several times as they had also visited a prior resident in the home who never expressed their personal rights being violated by staff. LPA received a statement from R1 who expressed staff are nice and there was one staff who already left the facility and they were not. R1 did not disclose the name of the staff or what they did that violated their personal rights. R1 was very vague and did not provide much information.

Although the allegation may be true, or are valid, there is not a preponderance of evidence to prove the alleged violations did, or did not, occur. Therefore, the allegation for Personal Rights is UNSUBSTANTIATED.

No citations issued regarding the above allegation.

SUPERVISOR'S NAME: Kimberley Mota	TELEPHONE: (707) 588-5051
LICENSING EVALUATOR NAME: Araceli Canela	TELEPHONE: (707) 588-5041
LICENSING EVALUATOR SIGNATURE:	DATE: 05/18/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/18/2023

LIC9099 (FAS) - (06/04)

Page: 2 of 2