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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 157203395
Report Date: 07/21/2022
Date Signed: 07/21/2022 12:50:39 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
04/08/2022 and conducted by Evaluator Shawna Doucette
COMPLAINT CONTROL NUMBER: 24-AS-20220408103448
FACILITY NAME:BROOKDALE RIVERWALKFACILITY NUMBER:
157203395
ADMINISTRATOR:WEBSTER, REGFACILITY TYPE:
741
ADDRESS:350 CALLOWAY DRTELEPHONE:
(661) 587-0221
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93312
CAPACITY:376CENSUS: 194DATE:
07/21/2022
UNANNOUNCEDTIME BEGAN:
11:36 AM
MET WITH:Administrator Reg WebsterTIME COMPLETED:
01:00 PM
ALLEGATION(S):
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Medical attention was not sought for resident in a timely manner.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Shawna Doucette conducted an unannounced complaint visit to deliver findings. LPA met with Administrator Reg Webster and discussed the purpose of the visit.

The Department has investigated the allegation: Medical attention was not sought for resident in a timely manner. .

According to interviews and record review, R1 fell on 12/15/21, 12/16/21, and 12/17/21. Facility had R1 placed on a two person assist to prevent falls. On 12/18/21 Staff was made aware of a change in condition which required emergency medical attention. Staff did not seek medical attention for several hours.

*Continued on 9099C
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Sergiy PidgirnyTELEPHONE: (559) 246-0610
LICENSING EVALUATOR NAME: Shawna DoucetteTELEPHONE: (559) 580-4595
LICENSING EVALUATOR SIGNATURE:

DATE: 07/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2022
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
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
04/08/2022 and conducted by Evaluator Shawna Doucette
COMPLAINT CONTROL NUMBER: 24-AS-20220408103448

FACILITY NAME:BROOKDALE RIVERWALKFACILITY NUMBER:
157203395
ADMINISTRATOR:WEBSTER, REGFACILITY TYPE:
741
ADDRESS:350 CALLOWAY DRTELEPHONE:
(661) 587-0221
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93312
CAPACITY:376CENSUS: 194DATE:
07/21/2022
UNANNOUNCEDTIME BEGAN:
11:36 AM
MET WITH:Administrator Reg WebsterTIME COMPLETED:
01:00 PM
ALLEGATION(S):
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9
Resident became severly dehydrated while in care.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Shawna Doucette conducted an unannounced complaint visit to deliver findings. LPA met with Administrator Reg Webster and discussed the purpose of the visit.


The Department has investigated the allegation: Resident became severly dehydrated while in care.

Based on record review and interviews, R1 was placed on a 72 hour watch at the facility. Per daily meal attendance R1 was provided with three meals a day and water. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

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

Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Sergiy PidgirnyTELEPHONE: (559) 246-0610
LICENSING EVALUATOR NAME: Shawna DoucetteTELEPHONE: (559) 580-4595
LICENSING EVALUATOR SIGNATURE:

DATE: 07/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 5 of 5
Control Number 24-AS-20220408103448
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/21/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/22/2022
Section Cited
CCR
87465(g)
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87465 Incidental Medical and Dental Care (g) The licensee shall immediately telephone 9-1-1 if an injury or other circumstance has resulted in an imminent threat to a resident’s health including, but not limited to, an apparent life-threatening medical crisis except as specified in Sections 87469(c)(2), (c)(3), or (c)(4).
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Plan of Correction POC Licensee agrees to submit a written plan on how the regulation will be met. Licensee agrees to conduct staff training regarding this regulation.
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This requirement was not met as evidenced by LIcensee did not call 911 once R1 had an emergency change in condition, which poses an immediate health, safety and/or personal rights risk to residents in care.
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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: Sergiy PidgirnyTELEPHONE: (559) 246-0610
LICENSING EVALUATOR NAME: Shawna DoucetteTELEPHONE: (559) 580-4595
LICENSING EVALUATOR SIGNATURE:

DATE: 07/21/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 24-AS-20220408103448
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: 07/21/2022
NARRATIVE
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Based on the Departments record review and interviews, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division 6, Chapter 8, Section 87465(g) is being cited on the attached LIC 9099D.

Civil penalties are pending and currently under review. The details of the civil penalties will be outlined in a future report to the facility.

An exit interview was conducted, a copy of this report was provided, and appeal rights were provided.

SUPERVISOR'S NAME: Sergiy PidgirnyTELEPHONE: (559) 246-0610
LICENSING EVALUATOR NAME: Shawna DoucetteTELEPHONE: (559) 580-4595
LICENSING EVALUATOR SIGNATURE:

DATE: 07/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2022
LIC9099 (FAS) - (06/04)
Page: 3 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
04/08/2022 and conducted by Evaluator Shawna Doucette
COMPLAINT CONTROL NUMBER: 24-AS-20220408103448

FACILITY NAME:BROOKDALE RIVERWALKFACILITY NUMBER:
157203395
ADMINISTRATOR:WEBSTER, REGFACILITY TYPE:
741
ADDRESS:350 CALLOWAY DRTELEPHONE:
(661) 587-0221
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93312
CAPACITY:376CENSUS: 194DATE:
07/21/2022
UNANNOUNCEDTIME BEGAN:
11:36 AM
MET WITH:Administrator Reg WebsterTIME COMPLETED:
01:00 PM
ALLEGATION(S):
1
2
3
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9
Neglect/ lack of supervision resulted in resident sustaining pressure injuries
Illegal eviction.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Shawna Doucette conducted an unannounced complaint visit to deliver findings. LPA met with Administrator Reg Webster and discussed the purpose of the visit.


The Department has investigated the allegations: Neglect/ lack of supervision resulted in resident sustaining pressure injuries and Illegal eviction.


Based on interviews, this agency has investigated the complaint alleging, Neglect/ lack of supervision resulted in resident sustaining pressure injuries and Illegal eviction. We have found that the complaint was UNFOUNDED, meaning that the allegation is false, could not have happened, and/or is without a reasonable basis, therefore we have dismissed the complaint.

An exit interview was conducted and a copy of this report was provided.
Unfounded
Estimated Days of Completion:
SUPERVISOR'S NAME: Sergiy PidgirnyTELEPHONE: (559) 246-0610
LICENSING EVALUATOR NAME: Shawna DoucetteTELEPHONE: (559) 580-4595
LICENSING EVALUATOR SIGNATURE:

DATE: 07/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 5