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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 155801189
Report Date: 03/10/2022
Date Signed: 03/11/2022 11:15:16 AM



STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1314 E SHAW AVE
FRESNO, CA 93710
This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/28/2021 and conducted by Evaluator Mary Garza
COMPLAINT CONTROL NUMBER: 24-AS-20210628140002
FACILITY NAME:WESTCHESTER GARDENSFACILITY NUMBER:
155801189
ADMINISTRATOR:ROBINSON, SHERVETAFACILITY TYPE:
740
ADDRESS:2228 TRUXTUN AVETELEPHONE:
(661) 324-3091
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93301
CAPACITY:36CENSUS: 14DATE:
03/10/2022
UNANNOUNCEDTIME BEGAN:
03:12 PM
MET WITH:Administrator, Sherveta RobinsonTIME COMPLETED:
03:28 PM
ALLEGATION(S):
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Staff mistreated residents
Facility has an outbreak of scabies
Staff did not properly supervise residents in care
Facility did not safeguard residents personal belongings
INVESTIGATION FINDINGS:
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On 3/10/2022 Licensing Program Analyst (LPA) M. Garza arrived at facility to conduct an unannouced complaint visit. LPA was COVID pre-screened and permitted entry. Reason for visit was discussed with Administrator, Sherveta Robinson. LPA toured facility inside and out. A Health and Safety check was completed on residents in care. Residents observed in common areas, in bedrooms and hallways.

During the complaint investigation LPA conducted interviews, reviewed physicians reports, special incident reports and observed videos. The following was found:

1) Staff mistreated residents-LPA observed video provided by Administrator showing S1 verbally being aggressive to a resident in care. Verbal aggression was further confirmed during interviews with staff.

2) Facility has an outbreak of scabies -Interviews with staff and records reviewed showed residents in care were diagnosed with scabies.

CONT...

Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Melinda HoffmannTELEPHONE: (559) 650-7914
LICENSING EVALUATOR NAME: Mary GarzaTELEPHONE: (559) 365-9009
LICENSING EVALUATOR SIGNATURE:

DATE: 03/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/10/2022
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
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1314 E SHAW AVE
FRESNO, CA 93710
This is an official report of an unannounced visit/investigation of a complaint received in our office on
06/28/2021 and conducted by Evaluator Mary Garza
COMPLAINT CONTROL NUMBER: 24-AS-20210628140002

FACILITY NAME:WESTCHESTER GARDENSFACILITY NUMBER:
155801189
ADMINISTRATOR:ROBINSON, SHERVETAFACILITY TYPE:
740
ADDRESS:2228 TRUXTUN AVETELEPHONE:
(661) 324-3091
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93301
CAPACITY:36CENSUS: 16DATE:
03/10/2022
UNANNOUNCEDTIME BEGAN:
03:12 PM
MET WITH:Administrator, Sherveta RobinsonTIME COMPLETED:
03:28 PM
ALLEGATION(S):
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3
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9
Staff member caused injuries to residents
Resident physically abused by an unknown visitor
Facility does not meet resident's nutritional needs
Staff takes illegal drugs
INVESTIGATION FINDINGS:
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On 3/10/2022 Licensing Program Analyst (LPA) M. Garza arrived at facility to conduct an unannouced complaint visit. LPA was COVID pre-screened and permitted entry. Reason for visit was discussed with Administrator, Sherveta Robinson. LPA toured facility inside and out. A Health and Safety check was completed on residents in care. Residents observed in common areas, in bedrooms and hallways.

During the complaint investigation LPA conducted interviews, reviewed physicians reports, special incident reports, hospice records and observed videos. The allegations listed above were found UNSUBSTANTIATED.

Exit interview conducted. A copy of this report will be emailed due to COVID precautionary measures. A delivered and read receipt serves as confirmation.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Melinda HoffmannTELEPHONE: (559) 650-7914
LICENSING EVALUATOR NAME: Mary GarzaTELEPHONE: (559) 365-9009
LICENSING EVALUATOR SIGNATURE:

DATE: 03/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/10/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 5 of 5
Control Number 24-AS-20210628140002
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1314 E SHAW AVE
FRESNO, CA 93710

FACILITY NAME: WESTCHESTER GARDENS
FACILITY NUMBER: 155801189
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/10/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
03/11/2022
Section Cited
CCR
87411(a)
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87411(a) Personnel Requirements – General
Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs.

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Staff involved terminiated. Administrator stated staff to be trained night supervision policy and CCL regulation. Adminsitrator to provide training log with signature and convered material to CCL by POC date.
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This requirement was not met as evidence by: LPA's interviews with Administrator and S2. Interviews showed an unknown visitor entering facility while staff was asleep. This poses an immediate Health & Safety risk to the residents in care.
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Type A
03/11/2022
Section Cited
CCR
87468.1(a)(3)
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87468.1(a)(3) Personal Rights of Residents in All Facilities. To be free from punishment, humiliation, intimidation, abuse, or other actions of a punitive nature, such as withholding residents’ money or interfering with daily living functions such as eating, sleeping, or elimination.
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S1 was terminated. Training on mandated reporting completed after incident (5/25/21). Administrator stated additional training of CCL regulations on personal rights will be completed. Covered material with signatures to be provided to CCL on or before POC due date.
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This requirement was not met as evidence by: LPA's interviews and observations of video provided by Administrator of S1 being verbally aggressive with a resident in care. Based on records reviewed and interviews this poses an immediate Health & Safety risk to the residents in care.
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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: Melinda HoffmannTELEPHONE: (559) 650-7914
LICENSING EVALUATOR NAME: Mary GarzaTELEPHONE: (559) 365-9009
LICENSING EVALUATOR SIGNATURE:

DATE: 03/10/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/10/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 24-AS-20210628140002
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1314 E SHAW AVE
FRESNO, CA 93710

FACILITY NAME: WESTCHESTER GARDENS
FACILITY NUMBER: 155801189
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/10/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
03/11/2022
Section Cited
CCR
87465(a)(1)
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87465(a)(1) - Incidental Medical and Dental Care. The licensee shall arrange, or assist in arranging, for medical and dental care appropriate to the conditions and needs of residents.


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Administrator stated training of contagious diseases and reporting requirements will be completed. Training material and sign in sheet to be provided to CCL by POC date.
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 This requirement was not met as evidenced by: LPA observation of records. Based on records reviewed, the facility had an outbreak of scabies, which poses an immediate Health & Safety risk to the residents in care.
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Type B
03/18/2022
Section Cited
CCR
87217(b)
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87217(b) Safeguards for Resident Cash, Personal Property, and Valuables
Every facility shall take appropriate measures to safeguard residents' cash resources, personal property and valuables which have been entrusted to the licensee or facility staff.

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Administrator stated that training will be compelted with all staff on CCL regulation on Safeguarding. Adminstrator to provide training material and sign in sheet to CCL by POC date.
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This requirement was not met as evidenced by: LPA's interview of Administrator and S2. Based on interviews, the facility had an unknown visitor in the facility at night who was going through residents personal belongings. This poses an potential Health & Safety risk to the residents in care.
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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: Melinda HoffmannTELEPHONE: (559) 650-7914
LICENSING EVALUATOR NAME: Mary GarzaTELEPHONE: (559) 365-9009
LICENSING EVALUATOR SIGNATURE:

DATE: 03/10/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/10/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 24-AS-20210628140002
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME: WESTCHESTER GARDENS
FACILITY NUMBER: 155801189
VISIT DATE: 03/10/2022
NARRATIVE
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CONT...

3) Staff did not properly supervise residents in care-During interviews with staff, it was confirmed that staff was asleep during their shift. This allowed an unknown visitor to enter the facility unnoticed.

4) Facility did not safeguard residents personal belongings- During interviews with staff it was confirmed an unknown visitor entered the facility at night unnoticed and went into residents rooms, through their belongings.

Based on the above information, the allegations listed above are found SUBSTANTIATED. Per Title 22, deficiencies are being cited on the attached LIC 9099D's. Appeal Rights discussed. Exit interview conducted. A copy of this report and appeal rights will be emailed due to COVID precautionary measures. A delivered and read receipt serves as confirmation.
SUPERVISOR'S NAME: Melinda HoffmannTELEPHONE: (559) 650-7914
LICENSING EVALUATOR NAME: Mary GarzaTELEPHONE: (559) 365-9009
LICENSING EVALUATOR SIGNATURE:

DATE: 03/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/10/2022
LIC9099 (FAS) - (06/04)
Page: 4 of 5