486803946-1-3-2024-21-AS-VBEI-CZDUVY-20240111145552

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 486803946
Report Date: 01/03/2024
Date Signed: 01/03/2024 06:06:17 PM

Unfounded

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
10/09/2023 and conducted by Evaluator Araceli Canela

PUBLIC

COMPLAINT CONTROL NUMBER: 21-AS-20231009140411

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: 13	DATE:	01/03/2024
		UNANNOUNCED	TIME BEGAN:	01:03 PM
MET WITH:	Cecilia Ganzon & Aurelia Renta, Administrator/Licensee		TIME COMPLETED:	03:14 PM

ALLEGATION(S):

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Staff inappropriately touches resident in care.
Staff is not providing residents’ medication as prescribed.
Neglect and Lack of Supervision resulting in resident not being provided adequate food service.

INVESTIGATION FINDINGS:

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At approximately 1:00PM, Licensing Program Analyst (LPA) Araceli Canela arrived at this facility unannounced, to continue investigation and deliver findings regarding the above allegations. LPA met with Administrator and both licensees, Cecilia Ganzon & Aurelia Renta.

It was alleged staff inappropriately touches resident in care; staff is not providing residents’ medication as prescribed and neglect and lack of supervision resulting in resident not being provided adequate food service. LPA conducted resident and staff interviews, reviewed records and requested more information from the reporting party. Based on information gathered, it was determined the staff in question for inappropriately touching resident and not providing adequate food service, has never worked or been employed at the facility. Complaint allegation only reported a first name of the staff and resident and staff interviewed did not know anyone by that name.
Continue report see LIC9099-C

Unfounded

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: 01/03/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/03/2024

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-20231009140411

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: 01/03/2024

NARRATIVE

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continue report from LIC9099

In addition, the allegation for staff is not providing residents’ medication as prescribed in that staff would crush medication and place it in the residents coffee cup. Staff member reported on complaint allegation to have done this, was also never an employee of this facility and the facility has not had a staff with that first name employed or working. Facility denies all allegations and expressed if they crush medication, they have a doctors order and this would not be placed in someone's coffee. Facility also expressed they provide adequate food service and their cook provides a large variety of options and residents are encouraged to eat. LPA has also observed on every inspection that has been conducted by LPA, the facility has a cook that is always cooking fresh food and food is adequate, in good condition and stored properly. LPA did not receive any additional information from reporting party and was unable to interview complainant. Based on information gathered and information that both names of staff identified in complaint allegation have never been employed or worked at this facility, all the above complaint allegations are UNFOUNDED, meaning that the allegations were false, could not have happened and/or is without a reasonable basis.

No citations issued for this complaint

SUPERVISOR'S NAME: Kimberley Mota	TELEPHONE: (707) 588-5051
LICENSING EVALUATOR NAME: Araceli Canela	TELEPHONE: (707) 588-5041
LICENSING EVALUATOR SIGNATURE:	DATE: 01/03/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/03/2024

LIC9099 (FAS) - (06/04)

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