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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157206770
Report Date: 11/29/2022
Date Signed: 11/29/2022 04:46:56 PM


Document Has Been Signed on 11/29/2022 04:46 PM - It Cannot Be Edited

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:POINTE AT SUMMIT HILLS, THEFACILITY NUMBER:
157206770
ADMINISTRATOR:BENNY FARILLASFACILITY TYPE:
740
ADDRESS:4501 UPLAND POINT DRIVETELEPHONE:
(661) 343-3244
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93306
CAPACITY:102CENSUS: 54DATE:
11/29/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
04:04 PM
MET WITH:Gracie Ramirez, Interim AdministratorTIME COMPLETED:
04:46 PM
NARRATIVE
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Licensing Program Analyst (LPA) L. Cabrera conducted a subsequent Case Management visit to discuss information obtained from a complaint investigation (24-AS-20220808110307) conducted on 08/16/2022 and 11/15/2022. LPA met with Gracie Ramirez, Interim Administrator (IA). LPA interviewed Staff, Residents, and reviewed 07/11/2022, 07/14/2022, 07/16/2022 call button records for the assisted living area. Residents reported facility staff would take long to respond. Upon review of the call buttons records, LPA observed several calls that had delayed response times. According to Interim Administrator and staff, facility staff are to respond within 10-15 minutes. Per records reviewed, facility would respond 30 minutes to an hour.

LPA met with IA to discuss information obtained from a second complaint investigation (24-AS-20221110085240) conducted on 11/15/2022. Facility staff did not administer residents' medications. IA admitted incident report regarding R1's medication error was not submitted to Community Care Licensing.

Deficiencies were cited on the LIC809D. Exit interview conducted.

A copy of Appeal Rights were provided to Interim Administrator.

SUPERVISOR'S NAME: Sergiy PidgirnyTELEPHONE: (559) 246-0610
LICENSING EVALUATOR NAME: Lady CabreraTELEPHONE: (559) 513-9832
LICENSING EVALUATOR SIGNATURE:
DATE: 11/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/29/2022
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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Document Has Been Signed on 11/29/2022 04:46 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1314 E SHAW AVE
FRESNO, CA 93710


FACILITY NAME: POINTE AT SUMMIT HILLS, THE
FACILITY NUMBER: 157206770

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/29/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
12/09/2022
Section Cited

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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... sufficient support staff shall be employed to ensure provision of personal assistance and care...
This requirement was not met as evidenced by:
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Based on records reviewed and interviews, this requirement was not met as evidenced by delayed response times to call buttons, which poses a potential health and safety risk to residents in care.
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Type B
12/09/2022
Section Cited

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87211 Reporting Requirements(a) Each licensee shall furnish to the licensing agency such reports as the Department may require...(1) A written report shall be submitted to the licensing agency and to the person responsible for the resident within seven days of the occurrence of any of the events…
This requirement is not met as evidenced by:
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Based on interviews, Licensee did not submit a incident report to CCL when the facility did not administer prescribed medication to resident, which poses a potential health and safety 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: Lady CabreraTELEPHONE: (559) 513-9832
LICENSING EVALUATOR SIGNATURE:
DATE: 11/29/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/29/2022
LIC809 (FAS) - (06/04)
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