157203395-3-5-2021-24-AS-SPIY-BZ5PCJ-20210315111157

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 157203395
Report Date: 03/03/2021
Date Signed: 03/05/2021 12:51:52 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
12/15/2020 and conducted by Evaluator Darius Williams

COMPLAINT CONTROL NUMBER: 24-AS-20201215121011

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: 192	DATE:	03/03/2021
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Administrator, Reg Webster		TIME COMPLETED:	10:30 AM

ALLEGATION(S):

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Staff are not meeting supervision needs of residents.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Darius Williams conducted a follow-up complaint visit and met with Administrator Reg Webster to deliver findings. Due to Covid-19 mitigation precautions the visit was conducted by phone.

On February 17, 2021 LPA Williams interviewed Staff 1, 2, and 3, who reported staff should respond to residents pendant system in seven to ten minutes.

Review of the pendant request system document reflects, between 1/18/2021 and 2/17/2021, responses exceeding ten minutes.

Resident 1 and Resident 2 reported response times exceeding ten minutes.

*Continued on LIC 9099C*

Substantiated

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: 03/03/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/03/2021

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-20201215121011

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: 03/03/2021

NARRATIVE

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Based on interviews and document review the preponderance of the evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code Regulation, Title 22, Division 6, Chapter 8, Section 87411(a), is being cited on the attached LIC9099D.

LPA Williams reviewed the LIC 9099D and plan of correction with the Administrator.

An exit interview was conducted with the Administrator. A copy of this report and appeals rights were provided.

SUPERVISOR'S NAME: Serigy Pidgirny	TELEPHONE: (559) 246-0610
LICENSING EVALUATOR NAME: Darius Williams	TELEPHONE: 559-243-8080
LICENSING EVALUATOR SIGNATURE:	DATE: 03/03/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/03/2021

LIC9099 (FAS) - (06/04)

Page: 2 of 4

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
12/15/2020 and conducted by Evaluator Darius Williams

COMPLAINT CONTROL NUMBER: 24-AS-20201215121011

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: 192	DATE:	03/03/2021
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	Administrator, Reg Webster		TIME COMPLETED:	10:30 AM

ALLEGATION(S):

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Staff did not assist residents with medications as needed.
Staff did not provide meals to residents
Personnel without qualifications are performing the assigned tasks of staff that are absent.
Facility is retaining residents beyond their level of care.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Darius Williams conducted a follow-up complaint visit and met with Administrator Reg Webster to deliver findings. Due to Covid-19 mitigation precautions the visit was conducted by phone.

LPA Williams previously interviewed the Administrator, three staff, two residents, and reviewed facility documents.

Although the allegation may have happened or is valid, there is not a preponderence of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.

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

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: 03/03/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/03/2021

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

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 24-AS-20201215121011

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: 03/03/2021

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 03/12/2021 Section Cited CCR 87411(a)	1 2 3 4 5 6 7	87411 Personnel Requirements - General, (a)Facility personnel shall at all times be sufficient in numbers, and competent to provide the services necessary to meet resident needs... This requirement was not met evidenced by:	1 2 3 4 5 6 7	The Administrator stated he will meet with the facility Health and Wellness Director to review staffing ratios. Additionally, the Administrator is conducting a meeting with staff by 3/10/2021 to review expectations and roles.
	8 9 10 11 12 13 14	Based on interviews and review of documentation, the Licensee did not ensure staff responded to residents in a timely manner, which poses a potential health and safety risk to persons in care.	8 9 10 11 12 13 14	The Administrator stated he will submit a staffing schedule and plan to reduce pendant response times to the Department by POC date of 3/12/2021.
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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: Serigy Pidgirny	TELEPHONE: (559) 246-0610
LICENSING EVALUATOR NAME: Darius Williams	TELEPHONE: 559-243-8080
LICENSING EVALUATOR SIGNATURE:	DATE: 03/03/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 03/03/2021

LIC9099 (FAS) - (06/04)

Page: 4 of 4