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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157203395
Report Date: 10/28/2020
Date Signed: 10/28/2020 01:33:15 PM

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:BROOKDALE RIVERWALKFACILITY NUMBER:
157203395
ADMINISTRATOR:WEBSTER, REGFACILITY TYPE:
741
ADDRESS:350 CALLOWAY DRTELEPHONE:
(661) 587-0221
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93312
CAPACITY:376CENSUS: 189DATE:
10/28/2020
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
08:44 AM
MET WITH:Administrator, Reg WebsterTIME COMPLETED:
09:04 AM
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Licensing Program Analyst (LPA) Darius Williams called Administrator, Reg Webster and conducted a case management via phone due to Covid-19 precautionary measures.

The purpose of the case management was to discuss an incident report dated 10/26/2020, regarding resident's (R1) missing medication. Administrator reported R1 still has a supply of the missing medication.

Administrator reported an internal investigation is being conducted and staff (S1) is currently suspended pending investigation. Re-training of medication procedures is being conducted with all med-techs and nurses.

LPA Williams requested the following documents to be submitted by Friday 10/30/2020:

- Internal investigation documents
- Centrally stored medication records
- Bakersfield Police event/case number

An exit interview was conducted with Administrator via telephone, a copy of this report was provided via email, and an electronic email read receipt confirms receiving these documents.
SUPERVISOR'S NAME: Serigy PidgirnyTELEPHONE: (559) 246-0610
LICENSING EVALUATOR NAME: Darius WilliamsTELEPHONE: 559-243-8080
LICENSING EVALUATOR SIGNATURE:

DATE: 10/28/2020
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/28/2020
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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