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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157202532
Report Date: 07/14/2022
Date Signed: 07/14/2022 01:08:39 PM

Document Has Been Signed on 07/14/2022 01:08 PM - It Cannot Be Edited

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:KERN TRANSITION HOME-RIVER GLENFACILITY NUMBER:
157202532
ADMINISTRATOR:GONZALEZ, TIFFANYFACILITY TYPE:
735
ADDRESS:4409 RIVER GLEN DRIVETELEPHONE:
(661) 213-3800
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93308
CAPACITY: 4CENSUS: 4DATE:
07/14/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
12:17 PM
MET WITH:Administrator, Brandy FrazierTIME COMPLETED:
01:33 PM
NARRATIVE
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On 07/14/2022, Licensing Program Analyst (LPA) Walton arrived unannounced to conduct a Case Management Visit. LPA introduced self and was granted entry to the facility. LPA requested to speak with the Administrator. LPA met with Administrator, Brandy Frazier.

The purpose of today’s visit is to follow up an Incident Report submitted to the Fresno CCL office on 05/16/2022:

It was reported that on 05/10/2022, resident R1 AWOL'd from the above facility. Facility staff last observed R1 at approximately 3:00AM. It was discovered that R1 was no longer in the facility when the next shift arrived and attempted to administer morning medication at 6:45AM. Facility staff contacted Bakersfield Police Department (BPD) and was notified that R1 was with an officer of BPD. R1 was transported back to the above facility at approximately 7:45AM.

Based on interviews conducted and record review a deficiency is being cited in accordance to the California Code of Regulations, Title 22, Division 6, see attached 809D. A civil penalty in the amount of $1000 for repeat violation is being assessed in accordance to the California Code of Regulations, Title 22, see attached LIC421IM.

An exit interview was conducted and a plan of correction was reviewed and developed with Administrator. A copy of this report and appeal rights were discussed and provided to Administrator, Brandy Frazier, whose signature on this form confirms receipt of this document.

SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Alexandria Walton
LICENSING EVALUATOR SIGNATURE: DATE: 07/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/14/2022
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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Document Has Been Signed on 07/14/2022 01:08 PM - It Cannot Be Edited


Created By: Alexandria Walton On 07/14/2022 at 12:21 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

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

FACILITY NAME: KERN TRANSITION HOME-RIVER GLEN
FACILITY NUMBER: 157202532

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/14/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/15/2022
Section Cited
CCR
85078(a)(1)

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85078 Responsibility for Providing Care and Supervision (1) The licensee shall provide those services identified in the client's needs and services plan as necessary to meet the client's needs. This requirement was not met as evidienced by:
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Licensee installed motion sensors around the facility, replaced the delayed egress system, and placed chimes on the windows to alert staff. Licensee also increased overnight supervision checks. POC cleared during visit.
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Based on interview and record review, Licensee did not ensure the requirements for the above regulation were met when R1 AWOL'd from the faciltiy and facility staff did not discover R1 was not in the facility for approximately 3 hours.
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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 Hoffmann
LICENSING EVALUATOR NAME:Alexandria Walton
LICENSING EVALUATOR SIGNATURE:
DATE: 07/14/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/14/2022


LIC809 (FAS) - (06/04)
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