155801264-5-26-2022-24-AS-SPIY-CEXU5G-20220531151641

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 155801264
Report Date: 05/26/2022
Date Signed: 05/26/2022 04:08:15 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, 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
02/03/2022 and conducted by Evaluator Shawna Doucette

COMPLAINT CONTROL NUMBER: 24-AS-20220203153443

FACILITY NAME:	HALLMARK OF BAKERSFIELD		FACILITY NUMBER:	155801264
ADMINISTRATOR:	MATTHEWS, SAVANNAH		FACILITY TYPE:	740
ADDRESS:	2001 AKERS ROAD		TELEPHONE:	(661) 834-0200
CITY:	BAKERSFIELD	STATE: CA	ZIP CODE:	93309
CAPACITY:	70	CENSUS: 49	DATE:	05/26/2022
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Administrator Darlene Ramero		TIME COMPLETED:	04:30 PM

ALLEGATION(S):

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Resident sustained injuries while in care
Staff handled resident in a rough manner
Staff failed to report incidents to resident's authorized representative
Staff failed to meet resident's needs

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Shawna Doucette contacted the facility to commence a complaint investigation. LPA conducted a visit and took COVID-19 pre-cautionary measures. LPA explained the purpose of the visit was to investigate the complaint and to deliver findings to Administrator Darlene Ramero.

LPA interviewed staff and conservator, and reviewed records. Although R1 may have recieved injuries while in care, facility properly assessed, documented and notified hospice of injuries.

LPA interviewed staff and conservator and was unable to determine if staff handled resident in a rough manner.

LPA interviewed staff and conservator, reviewed records and was unable to determine if facility failed to report incident's to resident's authorized representative.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Sergiy Pidgirny	TELEPHONE: (559) 650-7923
LICENSING EVALUATOR NAME: Shawna Doucette	TELEPHONE: (559) 580-4595
LICENSING EVALUATOR SIGNATURE:	DATE: 05/26/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/26/2022

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 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
02/03/2022 and conducted by Evaluator Shawna Doucette

COMPLAINT CONTROL NUMBER: 24-AS-20220203153443

FACILITY NAME:	HALLMARK OF BAKERSFIELD		FACILITY NUMBER:	155801264
ADMINISTRATOR:	MATTHEWS, SAVANNAH		FACILITY TYPE:	740
ADDRESS:	2001 AKERS ROAD		TELEPHONE:	(661) 834-0200
CITY:	BAKERSFIELD	STATE: CA	ZIP CODE:	93309
CAPACITY:	70	CENSUS: 49	DATE:	05/26/2022
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Administrator Darlene Ramero		TIME COMPLETED:	04:30 PM

ALLEGATION(S):

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Questionable death
Staff overdosed resident

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Shawna Doucette contacted the facility to commence a complaint investigation. LPA conducted a visit and took COVID-19 pre-cautionary measures. LPA explained the purpose of the visit was to investigate the complaint and to deliver findings to Administrator Darlene Ramero.

LPA interviewed staff and conservator. LPA was able to determine R1's death was not questionable after reviewing the hospice records and the death report.

LPA interviewed staff and conservator. LPA reviewed MARS log and hospice/medical records and was able to determine staff did not overdose the resident.

The Department has investigated the allegations: Questionable death and Staff overdosed resident. Based on the interviews and Records Review conducted it has been determined that the complaint was UNFOUNDED, therefore we have dismissed the complaint.

An exit interview and a copy of this report has been provided to the Administrator Darlene Ramero.

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Sergiy Pidgirny	TELEPHONE: (559) 650-7923
LICENSING EVALUATOR NAME: Shawna Doucette	TELEPHONE: (559) 580-4595
LICENSING EVALUATOR SIGNATURE:	DATE: 05/26/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/26/2022

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 2 of 3

Control Number 24-AS-20220203153443

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
	VISIT DATE: 05/26/2022

NARRATIVE

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LPA interviewed staff and conservator and reviewed records and was unable to determine if staff failed to meet residents needs.

Although the allegations Resident sustained injuries while in care, Staff handled resident in a rough manner, Staff failed to report incidents to resident's authorized representative, Staff failed to meet resident's needs may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegation are UNSUBSTANTIATED.

An exit interview, a copy of this report and appeal rights were provided to the Administrator Darlene Ramero.

SUPERVISOR'S NAME: Sergiy Pidgirny	TELEPHONE: (559) 650-7923
LICENSING EVALUATOR NAME: Shawna Doucette	TELEPHONE: (559) 580-4595
LICENSING EVALUATOR SIGNATURE:	DATE: 05/26/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/26/2022

LIC9099 (FAS) - (06/04)

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