486804054-1-27-2023-21-AS-CMAZ-CNWPW6-20230210104010

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 486804054
Report Date: 01/27/2023
Date Signed: 01/27/2023 04:50:43 PM

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
09/13/2022 and conducted by Evaluator Karina Canela

PUBLIC

COMPLAINT CONTROL NUMBER: 21-AS-20220913135310

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: 45	DATE:	01/27/2023
		UNANNOUNCED	TIME BEGAN:	01:41 PM
MET WITH:	Ensuida Real, Activity Director		TIME COMPLETED:	02:30 PM

ALLEGATION(S):

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Staff didn't treat the resident with dignity and respect

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Karina Canela arrived unannounced at Parkrose Gardens of Fairfield to deliver findings on complaint # 21-AS-20220913135310. LPA met with Ensuida Real, Activity Director. LPA investigated the above allegation “Staff didn't treat the resident with dignity and respect". During the investigation LPA requested and obtained copies of documents from the facility and relevant parties, interviews were conducted, and observations were made at Parkrose Gardens of Fairfield.
It was reported that residents are locked in the facility and are forced to take medications they don't want to take. It was also reported staff are verbally abusive and physically abusive to residents.

Due to a lack of witnesses and corroborating statements, LPA was unable to prove or disprove the allegation.
Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED. An exit interview was conducted with Ensuida Real, Activity Director whose signature on this form confirms receipt of these documents. No deficiencies cited regarding the above allegation during this inspection.

Unsubstantiated

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: 01/27/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/27/2023

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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