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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 157206770
Report Date: 11/29/2022
Date Signed: 11/30/2022 08:15:54 AM

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
11/10/2022 and conducted by Evaluator Lady Cabrera
PUBLIC
COMPLAINT CONTROL NUMBER: 24-AS-20221110085240
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
UNANNOUNCEDTIME BEGAN:
03:12 PM
MET WITH:Gracie Ramirez, Interim AdministratorTIME COMPLETED:
05:30 PM
ALLEGATION(S):
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Residents are not being their medications as prescribed.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) L. Cabrera conducted the subsequent complaint investigation visit to the facility. LPA met Gracie Ramirez, Interim Administrator. During the course of this complaint investigation LPA interviewed staff on duty and obtained and reviewed facility records. It was determined based on the interviews and records review that the above allegation is SUBSTANTIATED. Per records reviewed and interviews, facility did not administer Resident’s (R1) prescribed medication on 11/04/2022-11/06/2022 a total of three days. Facility staff received R6's medication on 9/16/2022, however, did not administered R6's medication until 10/01/2022. Facility administered incorrect medication for R7's on 11/09/2022.R7 notified facility on 11/10/2022 regarding the medication error.

Based on LPAs observations and interviews which were conducted, and record reviewed, 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), are being cited on the attached LIC 9099D.
Exit interview conducted. Appeal Rights were provided.
Substantiated
Estimated Days of Completion:
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.
LIC9099 (FAS) - (06/04)
Page: 1 of 2
Control Number 24-AS-20221110085240
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: 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 A
11/30/2022
Section Cited
CCR
87465(a)(4)
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87465 Incidental Medical and Dental Care (a) A plan for incidental medical and dental care shall be developed by each facility... (4) The licensee shall assist residents with self-administered medications as needed.
This requirement was not met as evidenced by:
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Licensee shall submit a plan of correction (POC) by 11/29/2022, that details the steps that will be taken to ensure all resident’s Centrally Stored Medication and Destruction Record (LIC622) to be updated with a start date, update records when pills are not given or missing to count for discrepancy, document correctly,

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Based on records reviewed and interviews, facility did not administer medications to Residents, which poses an Immediate health and safety risk to residents in care.
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and provide medication training to all staff that are involved in passing medications. The plan will include that all training be completed by 12/20/2022.
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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
LIC9099 (FAS) - (06/04)
Page: 2 of 2