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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 155801264
Report Date: 09/02/2021
Date Signed: 09/02/2021 02:29:59 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME:HALLMARK OF BAKERSFIELDFACILITY NUMBER:
155801264
ADMINISTRATOR:MATTHEWS, SAVANNAHFACILITY TYPE:
740
ADDRESS:2001 AKERS ROADTELEPHONE:
(661) 834-0200
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93309
CAPACITY:70CENSUS: 52DATE:
09/02/2021
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
09:15 AM
MET WITH:Savannah Matthews, AdministratorTIME COMPLETED:
09:45 AM
NARRATIVE
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On 9/2/21, Licensing Program Analyst (LPA) Malia Thao arrived unannounced to conduct a case management – deficiency inspection. LPA met with Administrator (ADM) Savannah Matthews and explained reason for inspection.

During complaint #24-AS-20200917134154, LPA found that the facility failed to submit an incident report concerning an incident involving a staff using alcohol wipes on R1’s bottom, instead of using the proper wipes for cleansing skin or an alternative proper cleansing material. Incident occurred approximately in September 2020. Staff (S1) admitted to incident of using alcohol wipes on R1’s bottom. Administrator admitted to having knowledge of incident at time of incident and had not submitted an incident report.

Deficiency is being cited based on LPA observations and interviews conducted in accordance with the California Code of Regulations, Title 22, see LIC809D.

Exit interview conducted. A copy of this report was emailed to Administrator Savannah Matthews at smatthews@bakersfieldcare.com.

SUPERVISOR'S NAME: Andy XiongTELEPHONE: (559) 650-7904
LICENSING EVALUATOR NAME: Malia ThaoTELEPHONE: (559) 650-7931
LICENSING EVALUATOR SIGNATURE:

DATE: 09/02/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/02/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

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

FACILITY NAME: HALLMARK OF BAKERSFIELD
FACILITY NUMBER: 155801264
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/02/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/09/2021
Section Cited

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87211 Reporting Requirements (a) Each licensee shall furnish to the licensing agency such reports as the Department may require, including, but not limited to, the following: (1) A written report shall be submitted to the licensing agency and to the person responsible for the resident within seven days of the occurrence of any of the events specified in (A) through (D) below...

This requirement is not met as evidenced by:
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During complaint #24-AS-20200917134154, LPA found that the facility failed to submit an incident report concerning an incident involving a staff using alcohol wipes on R1’s bottom, instead of using the proper wipes for cleansing skin or an alternative proper cleansing material. Incident occurred approximately in September 2020. Staff (S1) admitted to incident of using alcohol wipes on R1’s bottom. Administrator admitted to having knowledge of incident at time of incident and had not submitted an incident report. This poses a potential health, safety, and personal rights risk to 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: Andy XiongTELEPHONE: (559) 650-7904
LICENSING EVALUATOR NAME: Malia ThaoTELEPHONE: (559) 650-7931
LICENSING EVALUATOR SIGNATURE:
DATE: 09/02/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/02/2021
LIC809 (FAS) - (06/04)
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