486804054-6-22-2023-21-AS-HDBI-CTQPWQ-20230714114107

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 486804054
Report Date: 06/22/2023
Date Signed: 06/22/2023 06:42:13 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-20230308115000

FACILITY NAME:	PARKROSE GARDENS OF FAIRFIELD		FACILITY NUMBER:	486804054
ADMINISTRATOR:	SEABOURNE, JASMINE		FACILITY TYPE:	740
ADDRESS:	1095 EAST TABOR AVENUE		TELEPHONE:	(707) 422-1565
CITY:	FAIRFIELD	STATE: CA	ZIP CODE:	94533
CAPACITY:	102	CENSUS: 38	DATE:	06/22/2023
		UNANNOUNCED	TIME BEGAN:	03:00 PM
MET WITH:	Bill Heady, Acting Manager		TIME COMPLETED:	04:30 PM

ALLEGATION(S):

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Facility staff have not issued a refund to resident's authorized representative

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 DeBenedetti	TELEPHONE: (707) 588-5059
LICENSING EVALUATOR NAME: Karina Canela	TELEPHONE: 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)

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Control Number 21-AS-20230308115000

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:

Responsible parties (who paid in advance) of deceased residents or residents who have moved out of the facility have not received a refund check as required. Resident (R1) who moved out prior to the end of the month, allegedly waited over a month and did not receive their refund check. Resident (R2) who passed away and was paid for the month, R2's responsible party stated it had been over 2 months and they did not receive their refund check.

Complaint findings regarding “Facility staff have not issued a refund to resident's authorized representative” : Interviews conducted revealed refund checks were entered into Parkrose Gardens of Fairfield's system for the checks to be issued, but the facility could not confirm if the management company Ally Senior Living, LLC (also known as/formerly known as Align Senior Living, LLC) had paid the refund within 15 days of the resident's move out date (and removal of personal belongings). Review of records revealed 16 residents who moved out or who are deceased, that refund checks were requested between 01/01/2023 to 06/22/2023. LPA had requested from Parkrose Gardens of Fairfield, documentation and copies showing proof of when the refund checks were paid to the resident's responsible parties on 03/13/2023, 04/25/2023, 06/06/2023, and 06/22/2023. LPA only received copies of documentation for resident refund check requests for 13 residents (R1- R13) and a Refunds Report spreadsheet between 01/01/2023 - 06/23/2023 (for 9 residents [R1-R9]) which displayed the resident's name, payer type, amount, issue date, status, and payments/credits refunded. Refunds Report indicated 1 of 9 resident's refund was issued and 8 of 9 refund checks were sent. Additionally Staff (S1 & S2) stated the refunds are processed and issued by the accounting division which is located outside of the State of California. S1 & S2 stated they did not know regulation requires refunds to be paid within 15 days of when the resident's belongings are removed from the facility after move out or death. Facility was unable to provide documentation of the removal of resident's belongings and items that were removed. Facility staff (S3) stated the resident's belongs were removed on the date listed on the notes section of the Resident Refund Check Request.

This agency has investigated the complaint alleging "Facility staff have not issued a refund to resident's authorized representative”. Based on record review and interviews conducted, licensee did not pay the refunds to the resident's Responsible Party within the required 15 days after the removal of resident's belongings, therefore the preponderance of evidence standard has been met, the above allegation is found to be SUBSTANTIATED. California Health & Safety Code and Code of Regulations, (Title 22, Division 6 & Chapter 8), is being cited on the attached LIC 9099D. Appeal Rights Provided.

SUPERVISOR'S NAME: Hope DeBenedetti	TELEPHONE: (707) 588-5059
LICENSING EVALUATOR NAME: Karina Canela	TELEPHONE: 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)

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Control Number 21-AS-20230308115000

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 1569.652(c)	1 2 3 4 5 6 7	§1569.652 Termination of admission agreement upon death of resident; removal of resident’s property; refund of fees paid; notice of contract termination and refunds (c) A refund of any fees paid in advance covering the time after the resident’s personal property has been ...	1 2 3 4 5 6 7	Licensee to provide a written detailed plan on how the facility will ensure resident's refunds are issued accordingly and timely per H&SC. Facility to submit their plan to Community Care Licensing as plan of correction by POC due date 06/28/2023.
	8 9 10 11 12 13 14	removed from the facility shall be issued to the individual...responsible for the fees or... resident’s estate, within 15 days after the personal property is removed. This requirement was not met as evidenced by: Based on record review and statements received, licensee did not ensure the ...	8 9 10 11 12 13 14	--->Health & Safety Code 1569.652(c) as required. This is a potential personal rights risk to residents.
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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 DeBenedetti	TELEPHONE: (707) 588-5059
LICENSING EVALUATOR NAME: Karina Canela	TELEPHONE: 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)

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