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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 155801264
Report Date: 09/02/2021
Date Signed: 09/02/2021 02:59:33 PM



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
09/17/2020 and conducted by Evaluator Malia Thao
PUBLIC
COMPLAINT CONTROL NUMBER: 24-AS-20200917134154
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
UNANNOUNCEDTIME BEGAN:
08:40 AM
MET WITH:Savannah Matthews, AdministratorTIME COMPLETED:
09:15 AM
ALLEGATION(S):
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9
Staff caused injury to residents.
INVESTIGATION FINDINGS:
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On 9/2/21, Licensing Program Analyst (LPA) Malia Thao arrived unannounced to deliver findings. LPA met with Administrator (ADM) Savannah Matthews and explained reason for inspection.

During the course of the investigation, LPA made observations, conducted interviews, and reviewed records. Based on observations, interviews, and record reviews, LPA found that R5 obtained an injury after S5 used alcohol wipes on R5’s bottom instead of the proper cleansing wipes for skin, or an alternative proper cleansing material. S5 admitted to using alcohol wipes on R1’s bottom. ADM admitted S5 used alcohol wipes on R5 causing redness and irritation on R5’s bottom. The allegation is substantiated.

A deficiency is being cited based on LPA observation, interviews conducted, and record review in accordance with the California Code of Regulations, Title 22, see LIC9099D. An immediate civil penalty of $500 is hereby assessed, see LIC421IM.

An exit interview was conducted and Plans of Corrections were reviewed and developed with the Administrator. A copy of this report and appeal rights were discussed and emailed to Administrator Savannah Matthews at smatthews@bakersfieldcare.com.
Substantiated
Estimated Days of Completion:
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.
LIC9099 (FAS) - (06/04)
Page: 1 of 3
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
09/17/2020 and conducted by Evaluator Malia Thao
PUBLIC
COMPLAINT CONTROL NUMBER: 24-AS-20200917134154

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
UNANNOUNCEDTIME BEGAN:
08:40 AM
MET WITH:Savannah Matthews, AdministratorTIME COMPLETED:
09:15 AM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff do not meet residents’ needs.
INVESTIGATION FINDINGS:
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5
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13
On 9/2/21, Licensing Program Analyst (LPA) Malia Thao arrived unannounced to deliver findings. LPA met with Administrator (ADM) Savannah Matthews and explained reason for inspection.

During the course of the investigation, LPA made observations, conducted interviews, and reviewed records. Based on observations, interviews, and record reviews, there was insufficient evidence that staff did not meet residents' needs.

The allegations may have happened or is valid, but there is not a preponderance of the evidence to prove that the alleged violations occurred. The above allegations are unsubstantiated.

Exit interview conducted. A copy of this report was emailed to Administrator Savannah Matthews at smatthews@bakersfieldcare.com.
Unsubstantiated
Estimated Days of Completion:
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.
LIC9099 (FAS) - (06/04)
Page: 3 of 3
Control Number 24-AS-20200917134154
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: 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 A
09/03/2021
Section Cited
CCR
87468.1(a)(2)
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87468.1 Personal Rights of Residents in All Facilities (a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: (2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment.

This requirement is not met as evidenced by:
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Administrator states she will submit proof of plan for procedures for peri-care, and provide proof of in-service training and roster for all staff providing resident care to CCL by POC due date.
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During the course of the investigation, LPA found that R5 obtained an injury after S5 used alcohol wipes on R5’s bottom instead of the proper cleansing wipes for skin, or an alternative proper cleansing material. S5 admitted to using alcohol wipes on R1’s bottom. ADM admitted S5 used alcohol wipes causing redness and irritation on R5’s bottom. This poses an immediate 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
LIC9099 (FAS) - (06/04)
Page: 2 of 3