157203395-12-21-2021-24-AS-SPIY-C9ZLUA-20211224080336

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 157203395
Report Date: 12/20/2021
Date Signed: 12/21/2021 02:24:35 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
09/22/2021 and conducted by Evaluator Darius Williams

PUBLIC

COMPLAINT CONTROL NUMBER: 24-AS-20210922140831

FACILITY NAME:	BROOKDALE RIVERWALK		FACILITY NUMBER:	157203395
ADMINISTRATOR:	WEBSTER, REG		FACILITY TYPE:	741
ADDRESS:	350 CALLOWAY DR		TELEPHONE:	(661) 587-0221
CITY:	BAKERSFIELD	STATE: CA	ZIP CODE:	93312
CAPACITY:	376	CENSUS: 203	DATE:	12/20/2021
		UNANNOUNCED	TIME BEGAN:	12:02 PM
MET WITH:	Administrator, Reg Webster		TIME COMPLETED:	12:31 PM

ALLEGATION(S):

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Resident is being neglected at the facility.
Residents medications are not given according to the physician's direction.
Resident's needs are not being met by the facility staff.
Insufficient staffing numbers to meet resident's needs

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Darius Williams conducted an unannounced complaint visit to deliver findings. LPA Williams met with Administrator Reg Webster and discussed the purpose of the visit.

LPA Williams has investigated the above allegations and conducted interviews, record reviews, and observations.

On 9/23/2021, Resident 1 (R1) reported not having any concerns regarding the care provided at the facility. According to Witness 2 (W2), who visited R1 at the facility approximately 10 times, and wrote a letter to the facility on 9/8/2021, reported there were no concerns of care.

*Continued on LIC 9099C*

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Serigy Pidgirny	TELEPHONE: (559) 246-0610
LICENSING EVALUATOR NAME: Darius Williams	TELEPHONE: 559-243-8080
LICENSING EVALUATOR SIGNATURE:	DATE: 12/20/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/20/2021

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

LIC9099 (FAS) - (06/04)

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Control Number 24-AS-20210922140831

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: BROOKDALE RIVERWALK	FACILITY NUMBER: 157203395
	VISIT DATE: 12/20/2021

NARRATIVE

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On 9/23/2021, LPA Williams observed a pendant around R1’s neck, that is utilized to notify staff for assistance. R1 reported keeping the pendant around her neck and did not remember keeping it anywhere else. According to W2, Staff 1 (S1), Staff 2 (S1), and Staff 3 (S3), they all observed R1 with the pendant around her neck. According to the Administrator, S1, S2, S3, and Staff 4, there were times when staff responded to R1’s call pendant, but due to Witness 1’s behavior, the call light was not able to be cleared.

On 9/23/2021, LPA Williams observed staff actively assisting R1 with feeding, the room was clean and free of odor, and the refrigerator was stocked with assorted food supplies.

According to S1, S2, and S3, R1 was checked on approximately every hour or more as needed. According to facility documents, R1 was placed on a 30 minute check between 9/11/2021, and 9/22/2021, where staff signed and commented on R1’s status.

According to Omnihealth records, the facilities medication administration system, R1 was provided her medications.

Although the allegations 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 allegations are UNSUBSTANTIATED.

An exit interview was conducted and a copy of this report was provided.

SUPERVISOR'S NAME: Serigy Pidgirny	TELEPHONE: (559) 246-0610
LICENSING EVALUATOR NAME: Darius Williams	TELEPHONE: 559-243-8080
LICENSING EVALUATOR SIGNATURE:	DATE: 12/20/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/20/2021

LIC9099 (FAS) - (06/04)

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