486803946-9-17-2024-21-AS-KMOA-D9GP3K-20240926105736

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 486803946
Report Date: 09/17/2024
Date Signed: 09/17/2024 10:08:06 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
08/15/2024 and conducted by Evaluator David Leibert

COMPLAINT CONTROL NUMBER: 21-AS-20240815150548

FACILITY NAME:	PARKSIDE MANOR		FACILITY NUMBER:	486803946
ADMINISTRATOR:	GANZON, CECILIA		FACILITY TYPE:	740
ADDRESS:	50 CADLONI LN		TELEPHONE:	(707) 557-8991
CITY:	VALLEJO	STATE: CA	ZIP CODE:	94591
CAPACITY:	17	CENSUS: 14	DATE:	09/17/2024
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Lina Pascual		TIME COMPLETED:	10:30 AM

ALLEGATION(S):

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Staff are not assisting resident with transfers

INVESTIGATION FINDINGS:

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Licensing Program Analyst Leibert arrived unannounced for the purpose of delivering findings on this complaint. It has been alleged that staff have not assisted R1 with transfers. Title Twenty-Two requires, in part, the facility to assess a person's need for assistance with transferring and in meeting the needs identified in the appraisal. R1 requires assistance with transfers. This investigation has included a review of documents, unannounced site visits to the facility as well as interviews with staff and witnesses. Based upon the documents and statements, the following determinations are made: Staff state that efforts have consistently been made to assist R1 with transfers and that R1 has been periodically uncooperative with transfer efforts by staff; R1's behavior has deteriorated in the recent past and R1 refuses prescribed medications and routine hygiene care attempted by staff as well as other auxiliary services designed to assist in R1's rehabilitation. Based upon interviews, documents, and observations, staff have made reasonable efforts to assist R1 with transfers. Although the allegation may be true, or valid, there is not a preponderance of evidence to prove or, disprove, the allegation. Therefore, the allegation is UNSUBSTANTIATED. No citations issued today. Report left.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Carla Martinez	TELEPHONE: (707) 588-5059
LICENSING EVALUATOR NAME: David Leibert	TELEPHONE: (707) 588-5086
LICENSING EVALUATOR SIGNATURE:	DATE: 09/17/2024

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/17/2024

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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