<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 486804054
Report Date: 03/29/2024
Date Signed: 03/29/2024 03:26:29 PM


Document Has Been Signed on 03/29/2024 03:26 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		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 FAIRFIELDFACILITY NUMBER:
486804054
ADMINISTRATOR:MARLENE BREMERFACILITY TYPE:
740
ADDRESS:1095 EAST TABOR AVENUETELEPHONE:
(707) 422-1565
CITY:FAIRFIELDSTATE: CAZIP CODE:
94533
CAPACITY:102CENSUS: 0DATE:
03/29/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:37 PM
MET WITH:Marlene Bremer, AdministratorTIME COMPLETED:
03:45 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 3/29/2024, Licensing Program Analysts (LPA's) Tobola & Matialu arrived at this facility for the purpose of conducting a closure inspection pursuant to voluntary closure of this licensed Residential Care Facility for the Elderly and greeted by Administrator, Marlene Bremer.

LPA's conducted a walk-through of the facility, inspected all rooms and the exterior of the building. There are currently no residents living in the facility and with the last resident moved out on 3/27/2024. LPA's were provided with a list of all residents and relocation sites. During today's inspection LPA's found no evidence that would suggest that any residents are residing on the premises. There are three rooms with clothing items present and packed. Administrator stated that they've contacted resident families for pickup or delivery of items if requested. The facility files for both residents and staff have been consolidated and to be transferred to storage.

The Licensee initiated this facility closure and submitted a written statement to Community Care Licensing (CCL) on 2/7/2024, requesting to close this facility.

Closure inspection of this facility has been completed. Facility surrendered the license to LPA Tobola, and all postings have been removed. The Department will be moving forward with the closure process. LPA Tobola to finalize paperwork for final closure.

No deficiencies cited during today's visit.
SUPERVISOR'S NAME: Kimberley MotaTELEPHONE: (707) 588-5051
LICENSING EVALUATOR NAME: Dominic TobolaTELEPHONE: (707) 588-5081
LICENSING EVALUATOR SIGNATURE:
DATE: 03/29/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/29/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1