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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 157206770
Report Date: 07/18/2023
Date Signed: 07/18/2023 04:33:14 PM

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
05/16/2023 and conducted by Evaluator Shawna Doucette
COMPLAINT CONTROL NUMBER: 24-AS-20230516085639
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: 56DATE:
07/18/2023
UNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Administrator Griselda "Gracie" RamirezTIME COMPLETED:
05:00 PM
ALLEGATION(S):
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Resident was able to elope from the facility without staff supervision
Staff are not throwing away soiled depends in room
Resident missed medications
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Shawna Doucette conducted a visit to commence a complaint investigation and deliver findings. LPA identified herself and discussed the purpose of the visit and the elements of the allegations with Administrator Griselda "Gracie" Ramirez.

LPA reviewed records and interviewed staff and resident.

On 05/20/23, LPA interviewed staff. During the course of investigation, it was found R1 was originally placed in memory care due to dementia diagnosis. On 03/01/23, R1 was moved from memory care back to assisted living. On 04/29/23, R1 eloped from the facility. On 07/18/23, LPA reviewed records. R1's LIC602 states R1 cannot leave the faciity without supervision.

On 05/20/23 at 1:05 PM, while touring the facility, LPA observed a soiled diaper along with used gloves in an open overflowing trash can with no cover in residents bathroom. Photo was taken.

Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Sergiy PidgirnyTELEPHONE: (559) 246-0610
LICENSING EVALUATOR NAME: Shawna DoucetteTELEPHONE: (559) 580-4595
LICENSING EVALUATOR SIGNATURE:

DATE: 07/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2023
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 5
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
05/16/2023 and conducted by Evaluator Shawna Doucette
COMPLAINT CONTROL NUMBER: 24-AS-20230516085639

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: 56DATE:
07/18/2023
UNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Administrator Griselda "Gracie" RamirezTIME COMPLETED:
05:00 PM
ALLEGATION(S):
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Staff are not changing residents clothes daily
Staff are not ensuring resident has swallowed medication
Staff are not ensuring resident has depends on at all times
INVESTIGATION FINDINGS:
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Amend to add allegation

Licensing Program Analyst (LPA) Shawna Doucette arrived unannounced to conduct a complaint investigation and deliver findings. LPA met with Administrator Griselda "Gracie" Ramirez.

LPA interviewed staff and it was found R1's clothes are sometimes not changed daily due to R1 refusing to changed.
LPA interviewed staff and resident. While touring the facility, LPA did not observe medication on the floor in residents room.

LPA interviewed staff and was unable to determine whether or not R1 has depends on at all times.

Based on interviews and observation, it is undertimined if Staff are not changing residents clothes daily and Staff are not ensuring resident has swallowed medication. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.
An exit interview was conducted and a copy of this report was provided.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Sergiy PidgirnyTELEPHONE: (559) 246-0610
LICENSING EVALUATOR NAME: Shawna DoucetteTELEPHONE: (559) 580-4595
LICENSING EVALUATOR SIGNATURE:

DATE: 07/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 5 of 5
Control Number 24-AS-20230516085639
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: 07/18/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
07/19/2023
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: Licensee
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Plan of Correction POC Licensee agrees to submit a written statement regarding the understanding of the regulation and how it will met in the future including properly assessing residents prior to admission by POC due date 07/19/23. Civil Penalties were issued.
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did not provide care and supervision for R1 on 04/29/23 who is diagnosed with dementia per LIC602 and cannot leave facility unassisted. R1 was missing from the facility for about 10 minutes and was found down the street which poses an immdiate health, safety and/or personal rights risk to residents in care.
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Type A
07/19/2023
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. The plan shall encourage routine medical and dental care and provide for assistance in obtaining such
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Plan of Correction POC Licensee agrees to provide staff training on medication administration and documentation/charting by POC due date 08/04/23.

Civil Penalties were issued Repeat violation
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care, by compliance with the following: (4) The licensee shall assist residents with self-administered medications as needed.
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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: 07/18/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 5
Control Number 24-AS-20230516085639
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: 07/18/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
08/04/2023
Section Cited
CCR
87303(f)(1)
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87303 (f) Solid waste shall be stored and disposed of as follows: (1) Solid waste shall be stored, located and disposed of in a manner that will not permit the transmission of a communicable disease or of odors, create a nuisance, provide a breeding
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Plan of Correction POC Licensee agrees to provide training in properly disposing of incontinent/ hazardous materials by POC due date 08/4/23.
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place or food source for insects. This requirement was not met as evidenced by: Licensee did not properly dispose of soiled diaper and gloves. LPA observed and photographed an uncovered trash can in the residents bathroom that was full containing a soiled diaper and gloves which poses a potential health, safety and personal rights risk for 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: 07/18/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 24-AS-20230516085639
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
VISIT DATE: 07/18/2023
NARRATIVE
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On 07/18/23, LPA reviewed MARS log for May of 2023 for R1 and observed numerous medication errors. On 5/3/23, 05/09/23, 05/14/23, 05/15/23, 05/16/23 and 05/20/23 the MARS log shows R1 missed medications with no explanation. See attached documentation.

Based on record review, interviews, observation and photos the preponderance of evidence standard has been met; therefore, the above allegations are found to be Substantiated. Per Health and Safety and California Code of Regulations, Title 22, deficiencies are being cited on the attached 9099-D. Civil Penalties were issued for repeat violations.

An exit interview was conducted with Administrator Administrator Griselda "Gracie" Ramirez and a copy of this report along with appeal rights and plans of correction were provided.
SUPERVISOR'S NAME: Sergiy PidgirnyTELEPHONE: (559) 246-0610
LICENSING EVALUATOR NAME: Shawna DoucetteTELEPHONE: (559) 580-4595
LICENSING EVALUATOR SIGNATURE:

DATE: 07/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/18/2023
LIC9099 (FAS) - (06/04)
Page: 4 of 5