157203395-5-12-2022-24-AS-SPIY-CEKL5W-20220519082750

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 157203395
Report Date: 05/12/2022
Date Signed: 05/12/2022 05:13:38 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
01/26/2022 and conducted by Evaluator Shawna Doucette

COMPLAINT CONTROL NUMBER: 24-AS-20220126162955

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:	DATE:	05/12/2022
		UNANNOUNCED	TIME BEGAN:	09:30 AM
MET WITH:	Administrator Reg Webster		TIME COMPLETED:	05:30 PM

ALLEGATION(S):

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Lack of care and supervision resulted in resident death
Staff did not provide a resident access to a call button while in care
Resident was left soiled while in care
Resident was not provided adequate care and supervision while in care

INVESTIGATION FINDINGS:

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Licensing Program Analysts (LPA) Shawna Doucette contacted the facility to commence a complaint investigation. LPA conducted a visit and took COVID-19 pre-cautionary measures. LPA identified herself and explained the purpose of the visit and the elements of the allegations with Administrator Reg Webster.

LPA requested daily logs of ADL's. LPA interviewed staff and witnesses. LPA obtained copies of Hospice records. LPA reviewed records.

After reviewing records and conducting interviews, it was found R1 had a terminial medical condition which resulted in R1's passing.

After conducting interviews, it was found R1 had a call button around R1's neck and at her bedside to alert staff when R1 needed assistance

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: 05/12/2022

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)

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Control Number 24-AS-20220126162955

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: 05/12/2022

NARRATIVE

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After reviewing Hospice records, facility records and conducting interviews, it was found R1 was checked for soiling or changed frequently and was not left soiled.

After conducting interviews and reviewing the staff schedule, and staff daily logs if was found that the facility was providing enough care and supervision.

Although the allegations Lack of care and supervision resulted in resident death, Staff did not provide a resident access to a call button while in care, Resident was left soiled while in care, Resident was not provided adequate care and supervision while in care 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 is UNSUBSTANTIATED.

An exit interview was conducted with Administrator Reg Webster and a copy of this report was provided.

SUPERVISOR'S NAME: Sergiy Pidgirny	TELEPHONE: (559) 650-7923
LICENSING EVALUATOR NAME: Shawna Doucette	TELEPHONE: (559) 580-4595
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)

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