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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157206770
Report Date: 06/27/2023
Date Signed: 06/27/2023 12:23:26 PM


Document Has Been Signed on 06/27/2023 12:23 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) 447-4800
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93306
CAPACITY:102CENSUS: 57DATE:
06/27/2023
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
11:14 AM
MET WITH:Administrator Griselda "Gracie" RamirezTIME COMPLETED:
12:45 PM
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LPA Shawna Doucette arrived at the facility unannounced to conduct a case management that occurred on 06/19/23 regarding an AWOL. LPA was met by Staff Monica Ramirez who granted LPA entry into the facility. LPA met with Administrator Griselda "Gracie" Ramirez.

LPA conducted interviews and reviewed R1's file. R1 requires care and supervision. Facility filed a missing persons report #23-11846. After staff reviewed surveillance video, R1 was seen leaving the facility at around 6:40 AM. R1 was located by a citizen around 5:25 PM and returned to the facility.

LPA obtained copies of R1's file.

Per Health and Safety 1569.312, facility was cited for care and supervision and civil penalties were issued.

An exit interview was conducted with Administrator Griselda "Gracie" Ramirez and a copy of this report, appeal rights and plan of correction was provided.
SUPERVISOR'S NAME: Sergiy PidgirnyTELEPHONE: (559) 246-0610
LICENSING EVALUATOR NAME: Shawna DoucetteTELEPHONE: (559) 580-4595
LICENSING EVALUATOR SIGNATURE:
DATE: 06/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/27/2023
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 06/27/2023 12:23 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: 06/27/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
06/28/2023
Section Cited
HSC
1569.312

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1569.312 Basic services requirements Every facility required to be licensed under this chapter shall provide at least the following basic services: (a) Care and supervision as defined in Section 1569.2. This requirement was not met as evidenced by:
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Plan of Correction Licensee agrees to conduct staff training for care and supervision for residents in care. POC cleared during visit. Training documents provided.

Civil penalties issued.
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Facility did not provide care and supervision for R1 on 6/19/23 from 06:40 AM to 5:25 PM, when R1 was AWOL from the facility, which poses an immediate health, safety, and/or personal rights 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: Shawna DoucetteTELEPHONE: (559) 580-4595
LICENSING EVALUATOR SIGNATURE:
DATE: 06/27/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/27/2023
LIC809 (FAS) - (06/04)
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