486804054-4-26-2023-21-AS-CMAZ-CRPU2Y-20230510151241

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 486804054
Report Date: 04/25/2023
Date Signed: 04/26/2023 10:22:06 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
03/10/2023 and conducted by Evaluator Karina Canela

PUBLIC

COMPLAINT CONTROL NUMBER: 21-AS-20230310101914

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: 36	DATE:	04/25/2023
		UNANNOUNCED	TIME BEGAN:	09:20 AM
MET WITH:	Marlene Bremer, Administrator & Marketing Director		TIME COMPLETED:	10:00 AM

ALLEGATION(S):

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Staff did not secure the main door of the facility to prevent residents with dementia from exiting

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 Marlene Bremer, Administrator & Marketing Director. 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. It was reported to The Department of Social Services, Community Care Licensing Division, Santa Rosa Regional Office that the facility main front (delayed egress) door was not secured posing a concern to residents. Facility stated the delayed egress door alarm was not working for about a week, but the delayed egress component was operational. Additionally, the facility installed a manual auditory alarm on the main door temporarily until the alarm was repaired on 03/13/2023.
Due to a lack of corroborating statements and witnesses, 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 Administrator 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: 04/25/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/25/2023

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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