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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 486803946
Report Date: 07/13/2026
Date Signed: 07/13/2026 11:48:14 AM

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
07/09/2026 and conducted by Evaluator Marisol Cuadra
PUBLIC
COMPLAINT CONTROL NUMBER: 21-AS-20260709161548
FACILITY NAME:PARKSIDE MANORFACILITY NUMBER:
486803946
ADMINISTRATOR:ALINIO, RUBYFACILITY TYPE:
740
ADDRESS:50 CADLONI LNTELEPHONE:
(707) 557-8991
CITY:VALLEJOSTATE: CAZIP CODE:
94591
CAPACITY:17CENSUS: 13DATE:
07/13/2026
UNANNOUNCEDTIME BEGAN:
09:40 AM
MET WITH:Lina Pascual (Designated staff)TIME COMPLETED:
12:03 PM
ALLEGATION(S):
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-Personal Rights.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Cuadra arrived unannounced to conduct a complaint investigation and delivered findings regarding the allegation listed above and met with Ruby Alinio, administrator via phone who gave authorization for staff Lina Pascual to sign the report.

The Department received an allegation of personal rights. According to the Reporting Party, resident (R1) has bowel impairment condition that benefits from drinking coffee every day to help with constipation, but the facility regularly runs out of coffee resulting in R1 experiencing pain and not able to eat. On 7/13/26, LPA conducted 10-day visit to the facility, made observations, reviewed records and conducted confidential interviews with staff and residents in care. During the visit, LPA toured the kitchen and observed four jars of 10.5 ounces of Nescafe Clasico 150-cup, sugar and coffee creamer available for residents in care. Based on interviews conducted with residents (R1, R2, R3, R4 & R5) determined that they don’t have any issues when they want to drink coffee and some of them prefer not to drink coffee at all. Continue on LIC9099C...
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Marisol Cuadra
LICENSING EVALUATOR SIGNATURE:

DATE: 07/13/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/13/2026
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-20260709161548
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: 07/13/2026
NARRATIVE
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Continued from LIC9099...

Per R1, there are days that facility staff provided them with two cups of coffee, and at times they only gave them one cup of coffee, R1 disclosed that through the course of years the facility has been providing them with coffee when they want to get coffee, which it could be any brand, they don't have a brand preference as far as they gave them coffee when they request it. According to S1, they have coffee available for residents in care, but there is one resident who wants to go buy coffee whenever they want to go and the facility goes grocery shopping on Tuesdays when staff available will go and get items listed in the grocery list, but resident at times doesn't request to buy their coffee timely to be included to the weekly grocery list. However, it was confirmed through interviews that R1 doesn't have a preference of any specific brand and will drink any coffee that its available at the facility. Based on records review of R1’ physician report dated 6/30/22 revealed that R1 doesn’t have a special diet, but they do have a bowel impairment that results in constipation, which it’s being treated with a prescribed medication named polyethylene glycol 17 grams which is instructed to be taken one packet by mouth daily as needed for constipation to be dissolved in 4-8 ounces of beverage, but there is no indication that beverage has to be coffee. Based on LPA’s observations, records review and interviews conducted with involved parties doesn’t indicate that the facility is not providing residents with coffee to support above allegation. A finding that the complaint allegation of personal rights is unsubstantiated means that although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation(s) did or did not occur, therefore the allegation is UNSUBSTANTIATED.

SUPERVISORS NAME: Bethany Moellers
LICENSING EVALUATOR NAME: Marisol Cuadra
LICENSING EVALUATOR SIGNATURE:

DATE: 07/13/2026
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/13/2026
LIC9099 (FAS) - (06/04)
Page: 2 of 2