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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 157203395
Report Date: 10/24/2022
Date Signed: 10/24/2022 04:19:23 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SIERRA CASCADE AC/SC, 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
06/17/2022 and conducted by Evaluator Mary Garza
COMPLAINT CONTROL NUMBER: 24-AS-20220617090359
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: DATE:
10/24/2022
UNANNOUNCEDTIME BEGAN:
02:32 PM
MET WITH:TIME COMPLETED:
04:33 PM
ALLEGATION(S):
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Resident’s room had bed bugs.
Facility staff are not providing residents with food of good quality.
Facility food is not properly stored.
INVESTIGATION FINDINGS:
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On 10/24/22 Licensing Program Analyst (LPA) M. Garza arrived at facility unannounced to deliver findings on the allegations listed above. LPA introduced self, was COVID pre-screened and permitted entry into the facility. LPA met with Director, Reginald Webster and explained reason for visit. LPA completed a tour of the facility and completed a health and safety check on residents in care. Residents observed in common areas and in rooms.

Allegation: Resident’s room had bed bugs.
During investigation LPA completed interviews, obtained records (Interviews conducted with Staff and Assistant Director and records reviewed (pest control receipts, maintenance logs) indicated facility had bed bugs (in rooms 239, 240, 242, 249) in the facility.

Allegation: Facility staff are not providing residents with food of good quality.
During investigation LPA completed interviews and tour of the facility. LPA observed food in the kitchen had been prepped for service to residents. Food was uncovered, undated, in rusted/uncleaned trays and left on the countertops. CONT...
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: See MouaTELEPHONE: (559) -580-4596
LICENSING EVALUATOR NAME: Mary GarzaTELEPHONE: 559-365-9009
LICENSING EVALUATOR SIGNATURE:

DATE: 10/24/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/24/2022
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 4
Control Number 24-AS-20220617090359
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SIERRA CASCADE AC/SC, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME: BROOKDALE RIVERWALK
FACILITY NUMBER: 157203395
VISIT DATE: 10/24/2022
NARRATIVE
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Allegation: Facility food is not properly stored.

During investigation LPA toured facility and completed interviews. During tour of the kitchen, LPA observed food on the counter tops uncovered, food stored in the refrigerator was uncovered and undated.

Based on LPA’s interviews and records reviewed, the preponderance of evidence standard has been met. Therefore, the above allegations are found to be SUBSTANTIATED. Per California Code of Regulations, Title 22, deficiencies is being cited on the attached LIC 9099D.

Exit interview completed with Director, Reginald Webster. A copy of this report and appeal rights were provided.

SUPERVISOR'S NAME: See MouaTELEPHONE: (559) -580-4596
LICENSING EVALUATOR NAME: Mary GarzaTELEPHONE: 559-365-9009
LICENSING EVALUATOR SIGNATURE:

DATE: 10/24/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/24/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 4
Control Number 24-AS-20220617090359
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SIERRA CASCADE AC/SC, 1314 E SHAW AVE
FRESNO, CA 93710

FACILITY NAME: BROOKDALE RIVERWALK
FACILITY NUMBER: 157203395
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/24/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/04/2022
Section Cited
CCR
87468.1(a)(2)
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87468.1 Personal Rights of Residents in All Facilities (a) Residents in all residential care facilities for the elderly shall have all of the following personal rights: (2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment.
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Treatment of room has been completed resident(s) have since moved back into room. Resident cleaned and moved, checked by physicians, pest control is brought for treatment. Once cleared room is rechecked and resident moved back in once given the clearance. Documentation for the 4 rooms listed will be forwarded to CCL by POC date.
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This requirement was not met as evidence by: LPA interviews with staff completed and observation of pest control receipts and maintenance logs. Both indicated facility had bed bugs (in rooms 239, 240, 242, 249) in the facility. This poses a potential health, safety and/or personal rights risk to residents in care.
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Type B
10/24/2022
Section Cited
CCR
87555(b)(8)
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87555 General Food Service Requirements (b) The following food service requirements shall apply: (8) All food shall be of good quality...
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Per Exectutive Director, training will be completed with all staff. In service with all staff to get rid of rusted trays and clean all others. Label and dates and storage and cleaning schedules will be covered in training.A copy of the training and training material along with sign in sheet will be provided to CCL by POC date.
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This requirement was not met as evidence by: LPA observation of food in the kitchen had been prepped for service to residents. Food was uncovered, undated, in rusted/uncleaned trays and left on the countertops. This poses a potential 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: See MouaTELEPHONE: (559) -580-4596
LICENSING EVALUATOR NAME: Mary GarzaTELEPHONE: 559-365-9009
LICENSING EVALUATOR SIGNATURE:

DATE: 10/24/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/24/2022
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 24-AS-20220617090359
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SIERRA CASCADE AC/SC, 1314 E SHAW AVE
FRESNO, CA 93710

FACILITY NAME: BROOKDALE RIVERWALK
FACILITY NUMBER: 157203395
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/24/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
11/04/2022
Section Cited
CCR
87555(b)(23)
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87555 General Food Service Requirements (b) The following food service requirements shall apply: (23) All readily perishable foods or beverages capable of supporting rapid and progressive growth of micro-organisms which can cause food infections or food intoxications shall be stored in covered containers at appropriate temperatures.
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Per Exectutive Director, training will be completed with all staff. In service with all staff to get rid of rusted trays and clean all others. Label and dates and storage and cleaning schedules will be covered in training.A copy of the training and training material along with sign in sheet will be provided to CCL by POC date.
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This requirement was not met as evidence by: LPA observation. During tour of the kitchen, LPA observed food on the countertops uncovered, food stored in the refrigerator was uncovered and undated.
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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: See MouaTELEPHONE: (559) -580-4596
LICENSING EVALUATOR NAME: Mary GarzaTELEPHONE: 559-365-9009
LICENSING EVALUATOR SIGNATURE:

DATE: 10/24/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/24/2022
LIC9099 (FAS) - (06/04)
Page: 4 of 4