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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 155801279
Report Date: 05/12/2022
Date Signed: 05/17/2022 04:13:35 PM

Substantiated


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
03/02/2022 and conducted by Evaluator Lisa Salazar
COMPLAINT CONTROL NUMBER: 24-AS-20220302153559
FACILITY NAME:GABLES, THEFACILITY NUMBER:
155801279
ADMINISTRATOR:ESTHER MAESEFACILITY TYPE:
740
ADDRESS:903 SPIRIT LAKE DRIVETELEPHONE:
(661) 213-3927
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93312
CAPACITY:6CENSUS: 4DATE:
05/12/2022
UNANNOUNCEDTIME BEGAN:
02:59 PM
MET WITH:Administrator Stephanie Haro &
Executive Director Michelle Macias 		TIME COMPLETED:
04:45 PM
ALLEGATION(S):
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Staff are not properly trained
INVESTIGATION FINDINGS:
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On 05/12/2022, Licensing Program Analyst (LPA) L. Salazar arrived at the facility unannounced to deliver findings on the above allegation. LPA was greeted by Staff S1, explained purpose of the visit and was allowed entry into the facility. COVID precautionary measures were taken prior to entry.

During the investigation, LPA reviewed facility files including staff records. LPA did not observe training records and facility was unable to provide proof of training for staff.

Based on LPA’s observation, the preponderance of evidence standard has been met; therefore, the above allegation is found to be Substantiated. Per California Code of Regulations, Title 22, Division 6, Chapter 8, a deficiency is being cited on the attached 9099-D.

An exit interview was conducted with Executive Director, Michelle Macias. A copy of this report and appeal rights were discussed and provided. A plan of correction was developed with Administrator and reviewed with LPA.


Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Melinda HoffmannTELEPHONE: (559) -65-7914
LICENSING EVALUATOR NAME: Lisa SalazarTELEPHONE: (559) 691-0004
LICENSING EVALUATOR SIGNATURE:

DATE: 05/12/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/12/2022
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
Control Number 24-AS-20220302153559
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: GABLES, THE
FACILITY NUMBER: 155801279
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/12/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/25/2022
Section Cited
CCR
87412(c)(2)(D)
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(c) Licensees shall maintain in the personnel records verification of required staff training and orientation. (2) Documentation of staff training shall include: (D) Number of training hours per subject.
This requirement was not met as evidenced by LPA's observation of personnel records. Personnel records did not have proof of staff training and facility did not provide proof of training as requested on 03/11/22.
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Administrator will submit proof of training records for all staff. Proof of training records will include initial and continued training required for staff and also the required dementia training according to CCR Title 22 - 87705 by POC date.
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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) -65-7914
LICENSING EVALUATOR NAME: Lisa SalazarTELEPHONE: (559) 691-0004
LICENSING EVALUATOR SIGNATURE:

DATE: 05/12/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/12/2022
LIC9099 (FAS) - (06/04)
Page: 5 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
03/02/2022 and conducted by Evaluator Lisa Salazar
COMPLAINT CONTROL NUMBER: 24-AS-20220302153559

FACILITY NAME:GABLES, THEFACILITY NUMBER:
155801279
ADMINISTRATOR:ESTHER MAESEFACILITY TYPE:
740
ADDRESS:903 SPIRIT LAKE DRIVETELEPHONE:
(661) 213-3927
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93312
CAPACITY:6CENSUS: 4DATE:
05/12/2022
UNANNOUNCEDTIME BEGAN:
02:59 PM
MET WITH:Administator Stephanie Haro &
Executive Director Michelle Macias		TIME COMPLETED:
04:45 PM
ALLEGATION(S):
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Facility has no Administrator
Resident's files are not up to date
Staff have no files
INVESTIGATION FINDINGS:
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On 05/12/2022, Licensing Program Analyst (LPA) L. Salazar arrived at the facility unannounced to deliver findings on the above allegations. LPA was greeted by Staff S1, explained purpose of the visit and was allowed entry into the facility. COVID precautionary measures were taken prior to entry.

During the investigation, LPA reviewed facility files that include resident and staff records. Administrator change was recieved by facility on 02/25/22. LPA observed resident files to be current and up to date. Staff files contained required LIC forms per LIC 311F. LPA observed completed Centrally Stored Medication Destruction Records (CSMDR) in resident files. Medications were compared to CSMDR and reveal to be current, with the correct Rx# and start date.

Based on the information observed, the above allegations are unfounded, meaning that the allegations are false, could not have happened and or are without reasonable basis. Exit interview conducted. No deficiencies cited.
Unfounded
Estimated Days of Completion:
SUPERVISOR'S NAME: Melinda HoffmannTELEPHONE: (559) -65-7914
LICENSING EVALUATOR NAME: Lisa SalazarTELEPHONE: (559) 691-0004
LICENSING EVALUATOR SIGNATURE:

DATE: 05/12/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/12/2022
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 5
Control Number 24-AS-20220302153559
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: GABLES, THE
FACILITY NUMBER: 155801279
VISIT DATE: 05/12/2022
NARRATIVE
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(Continued from 9099)

An exit interview was conducted with Administrator. A copy of this report and appeal rights were discussed and provided. A plan of correction was developed and reviewed with LPA.
SUPERVISOR'S NAME: Melinda HoffmannTELEPHONE: (559) -65-7914
LICENSING EVALUATOR NAME: Lisa SalazarTELEPHONE: (559) 691-0004
LICENSING EVALUATOR SIGNATURE:

DATE: 05/12/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/12/2022
LIC9099 (FAS) - (06/04)
Page: 4 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
03/02/2022 and conducted by Evaluator Lisa Salazar
COMPLAINT CONTROL NUMBER: 24-AS-20220302153559

FACILITY NAME:GABLES, THEFACILITY NUMBER:
155801279
ADMINISTRATOR:ESTHER MAESEFACILITY TYPE:
740
ADDRESS:903 SPIRIT LAKE DRIVETELEPHONE:
(661) 213-3927
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93312
CAPACITY:6CENSUS: 4DATE:
05/12/2022
UNANNOUNCEDTIME BEGAN:
02:59 PM
MET WITH:Administator Stephanie Haro &
Executive Director Michelle Macias 		TIME COMPLETED:
04:45 PM
ALLEGATION(S):
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5
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9
Staff are falsifying documents
Staff are not signing off on medications
INVESTIGATION FINDINGS:
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On 05/12/2022, Licensing Program Analyst (LPA) L. Salazar arrived at the facility unannounced to deliver findings on the above allegations. LPA was greeted by Staff S1, explained purpose of the visit and was allowed entry into the facility. COVID precautionary measures were taken prior to entry.

During the investigation, LPA reviewed facility files that included resident and staff records. Review of training certificates revealed to be generic and incomplete.

Based on the information observed, although the allegations may have happened, there is not a preponderance of evidence to prove that the alleged violations occurred, therefore the allegations are unsubstantiated. No deficiencies cited. Exit interview conducted and copy of report was left at the facility. .

Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Melinda HoffmannTELEPHONE: (559) -65-7914
LICENSING EVALUATOR NAME: Lisa SalazarTELEPHONE: (559) 691-0004
LICENSING EVALUATOR SIGNATURE:

DATE: 05/12/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/12/2022
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 5