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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157206770
Report Date: 12/30/2022
Date Signed: 12/30/2022 05:27:56 PM


Document Has Been Signed on 12/30/2022 05:27 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
SIERRA CASCADE AC/SC, 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:
12/30/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
03:15 PM
MET WITH:Wellness Director Missy CamberosTIME COMPLETED:
04:02 PM
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Licensing Program Analyst (LPA) K.Kaur arrived unannounced to conduct a case management visit due to a recent incident report. LPA met with Wellness Director Missy Camberos regarding self-reported medication error that occurred on 11/21/2022

CCL received report that indicated Resident #1 missed medication from 11/17/22 to 11/22/22 due misunderstanding of medication prescription.



LPA discussed incident with assistant administrator Gracie Ramirez via telephone who stated R1 was on Hospice care and medication is refilled by Hospice nurses. Based on interviews and information gathered Facility followed proper procedures. No deficiencies cited

Exit interview was conducted with Wellness Director Missy Camberos. Report signed and printed copy provided.
SUPERVISOR'S NAME: See MouaTELEPHONE: (559) -58-4596
LICENSING EVALUATOR NAME: Kamaldeep KaurTELEPHONE: 559-243-8080
LICENSING EVALUATOR SIGNATURE:
DATE: 12/30/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/30/2022
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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