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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 486804054
Report Date: 06/22/2023
Date Signed: 06/22/2023 06:25:00 PM

Substantiated


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
03/08/2023 and conducted by Evaluator Karina Canela
PUBLIC
COMPLAINT CONTROL NUMBER: 21-AS-20230308114107
FACILITY NAME:PARKROSE GARDENS OF FAIRFIELDFACILITY NUMBER:
486804054
ADMINISTRATOR:SEABOURNE, JASMINEFACILITY TYPE:
740
ADDRESS:1095 EAST TABOR AVENUETELEPHONE:
(707) 422-1565
CITY:FAIRFIELDSTATE: CAZIP CODE:
94533
CAPACITY:102CENSUS: 38DATE:
06/22/2023
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Bill Heady, Acting AdministratorTIME COMPLETED:
03:00 PM
ALLEGATION(S):
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Staff do not provide resident with clean clothing.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Karina Canela arrived unannounced at Parkrose Gardens of Fairfield to deliver complaint findings. LPA met with staff Arthur William "Bill" Heady, who will be taking over as Administrator. Complaint was received prior to arrival of current administrator Bill Heady.

LPA investigated the above allegation. During the investigation LPA requested and obtained copies of documents from the facility. Interviews were conducted with relevant parties and observations were made.

Report continued on LIC9099-C
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Hope DeBenedettiTELEPHONE: (707) 588-5059
LICENSING EVALUATOR NAME: Karina CanelaTELEPHONE: 707-588-5054
LICENSING EVALUATOR SIGNATURE:

DATE: 06/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/22/2023
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 5
Control Number 21-AS-20230308114107
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: PARKROSE GARDENS OF FAIRFIELD
FACILITY NUMBER: 486804054
VISIT DATE: 06/22/2023
NARRATIVE
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The following was reported to The State of California Department of Social Services (DSS), Community Care Licensing Division (CCLD), Santa Rosa Regional Office:

    The facility’s washing machine had been out of service for approximately three weeks. Residents did not have clean clothing and linen as a result of the inoperable washing machine. Residents were reportedly wearing their day clothing for several days. Reporting party was told the reason why the washing machine was inoperable is because it needed a part replaced and Parkrose’s management company may not have been paying for the maintenance of the washer.

Complaint findings regarding “Staff do not provide resident with clean clothing”


LPA conducted an inspection of the facility 03/13/2023 and observed storage of approximately 29 full heavy duty large trash bags containing soiled resident’s clothing and linen (towels, bedding, blankets, etc.) in a vacant resident room. Interviews conducted confirmed the facility had one industrial sized washing machine which became inoperable for approximately three weeks. During that time frame, staff stated they were taking soiled laundry to a laundry mat to wash and dry resident’s clothing and linen. However, due to the amount of soiled clothing and linen, the facility was unable to keep up with washing all of the soiled clothing and linen which was being stored in large heavy duty trash bags in a vacant resident room. Parkrose Gardens of Fairfield staff stated they purchased regular sized washing machines shortly after LPA's inspection on 03/13/203 since the industrial sized washing machine had not been fixed yet. Additionally, during inspection on 03/13/2023, LPA observed resident (R1)’s bedsheets/linen and mattress to be soiled with dried feces (photos taken).


This agency has investigated the complaint alleging "Staff do not provide resident with clean clothing”. Based on LPA's observations and interviews conducted services of providing clean clothing and linen to residents were disrupted, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations and Health & Safety Code, (Title 22, Division 6 & Chapter 8), is being cited on the attached LIC 9099D. Appeal rights provided.
SUPERVISOR'S NAME: Hope DeBenedettiTELEPHONE: (707) 588-5059
LICENSING EVALUATOR NAME: Karina CanelaTELEPHONE: 707-588-5054
LICENSING EVALUATOR SIGNATURE:

DATE: 06/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/22/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 21-AS-20230308114107
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: PARKROSE GARDENS OF FAIRFIELD
FACILITY NUMBER: 486804054
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/22/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/28/2023
Section Cited
HSC
1569.312(a)
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§1569.312 Basic services requirements: Every facility required to be licensed under this chapter shall provide at least the following basic services: (a) Care and supervision as defined in Section 1569.2.
This requirement was not met as evidence by:
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Licensee to provide a written detailed plan on how the facility will ensure residents are assisted with activities of daily living and provide/assist residents with clean clothing and linen. Facility plan to be submitted to Community Care Licensing as plan of correction by POC due date 06/28/2023.
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Based on observation and interviews conducted, licensee did not ensure the H&SC above due to the facility not providing adequate clean clothing and linen to residents as required. This is a potential health, safety and personal rights risk to residents in care
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Type B
06/28/2023
Section Cited
CCR
87303(g)(1)
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87303 Maintenance and Operation: (g) Facilities which have machines and do their own laundry shall: (1) Have adequate supplies available and equipment maintained in good repair.
This requirement was not met as evidence by:
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Facility purchased washing machines to provide laundry service for residents. Licensee to submit a statement that they will ensure the facility will be maintained in good repair and notify Community Care Licensing when any resident services are disrupted and provide a plan of mitigation
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Based on observation & interviews conducted, licensee did not ensure the regulation above due to the facility's washing machine being inoperable for about 3 weeks resulting in lack of clean clothing/ linen available for residents. This is a potential health, safety and personal rights risk to residents in care
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Facility plan to be submitted to Community Care Licensing as plan of correction by POC due date 06/28/2023.
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Hope DeBenedettiTELEPHONE: (707) 588-5059
LICENSING EVALUATOR NAME: Karina CanelaTELEPHONE: 707-588-5054
LICENSING EVALUATOR SIGNATURE:

DATE: 06/22/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/22/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 5
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
03/08/2023 and conducted by Evaluator Karina Canela
COMPLAINT CONTROL NUMBER: 21-AS-20230308114107

FACILITY NAME:PARKROSE GARDENS OF FAIRFIELDFACILITY NUMBER:
486804054
ADMINISTRATOR:SEABOURNE, JASMINEFACILITY TYPE:
740
ADDRESS:1095 EAST TABOR AVENUETELEPHONE:
(707) 422-1565
CITY:FAIRFIELDSTATE: CAZIP CODE:
94533
CAPACITY:102CENSUS: 38DATE:
06/22/2023
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Bill Heady, Acting AdministratorTIME COMPLETED:
03:00 PM
ALLEGATION(S):
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Facility is in financial distress.

Resident's heater is in disrepair.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Karina Canela arrived unannounced at Parkrose Gardens of Fairfield to deliver complaint findings. LPA met with staff Arthur William "Bill" Heady, who will be taking over as Administrator. Complaint was received prior to arrival of current administrator Bill Heady.

LPA investigated the above allegations. During the investigation LPA requested and obtained copies of documents from the facility. Interviews were conducted with relevant parties and observations were made.

Report continued on LIC9099-C
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Hope DeBenedettiTELEPHONE: (707) 588-5059
LICENSING EVALUATOR NAME: Karina CanelaTELEPHONE: 707-588-5054
LICENSING EVALUATOR SIGNATURE:

DATE: 06/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/22/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 21-AS-20230308114107
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: PARKROSE GARDENS OF FAIRFIELD
FACILITY NUMBER: 486804054
VISIT DATE: 06/22/2023
NARRATIVE
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The following was reported to The Department of Social Services, Community Care Licensing Division, Santa Rosa Regional Office:
    The facility Parkrose Gardens of Fairfield is experiencing financial distress because the management company Ally Senior Living, LLC (also known as/formerly known as Align Senior Living, LLC) was allegedly not paying their bills and causing a delay in repairs such as the washing machine (which was inoperable since early March 2023) and resident's bedroom heater/air conditioning (AC) units. It was reported a resident's heater/AC unit was not working and was not replaced by a new unit, but was replaced by a heater/AC unit from another resident's room.

Allegation: Facility is in financial distress
Statements received alleged Parkrose's corporate card for maintenance might not have been paid in a timely manner. Observations and other statements received did not corroborate the allegation as the facility did purchase 2 washing machines in April 2023. Marketing Director denied the allegation and stated the delay in repairs was due to management from the previous Administrator (who is no longer working at the facility).
Allegation: Resident's heater is in disrepair
Inspection of heater units did not corroborate the allegation of a heater unit in disrepair. Statements received indicated heater/AC unit was replaced with another heater/AC unit which was operable. Additionally LPA conducted inspections on 03/13/2023, 04/25/2023, and 06/06/2023 of resident's heater/AC units and did not observe the units to be inoperable. LPA did observe one resident bedroom, which was vacant, to have a missing heater/AC unit. Marketing Director stated it would be replaced prior to any resident moving into or utilizing the bedroom.

Due to a lack of corroborating statements, information received, and witnesses, LPA was unable to prove or disprove the allegations. Although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED.
An exit interview was conducted with acting Administrator whose signature on this form confirms receipt of these documents. No deficiencies cited regarding the above allegations during this inspection.
SUPERVISOR'S NAME: Hope DeBenedettiTELEPHONE: (707) 588-5059
LICENSING EVALUATOR NAME: Karina CanelaTELEPHONE: 707-588-5054
LICENSING EVALUATOR SIGNATURE:

DATE: 06/22/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/22/2023
LIC9099 (FAS) - (06/04)
Page: 5 of 5