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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 157206770
Report Date: 04/12/2023
Date Signed: 04/12/2023 01:41:33 PM

Unsubstantiated


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
02/17/2023 and conducted by Evaluator Shawna Doucette
PUBLIC
COMPLAINT CONTROL NUMBER: 24-AS-20230217092817
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:
04/12/2023
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Griselda "Gracie" Ramirez, AdministratorTIME COMPLETED:
01:45 PM
ALLEGATION(S):
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Passageways are not free of obstruction
Facility has pests
Resident was not showered
Medication errors
INVESTIGATION FINDINGS:
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The Department investigated the above allegations and based on interviews and observation, there is not a preponderance of evidence to prove or disprove the allegations occurred therefore the complaint is unsubstantiated. R2's room was toured and no passageway obstructions were observed or reported by R2 or R2's spouse, whom R2 shares a room. R3's room was toured and no pests were observed and pest control records indicate that service was conducted in December 2022, and January and February 2023 in the kitchen, common, and perimeter areas. S1 stated that R4 refuses assistance with showering and will not allow staff in the room. Interview with R4 was unsuccessful in obtaining information regarding this allegation. It was reported and observed that facility reported this concern to the Long-term Care Ombudsman. Based on interviews with the Medication Technician, R5 and R5's responsible party (RP), R5 did not miss any medications when R5's insulin pen broke on 3/2/23. R5's regular pharmacy ordered a replacement pen stat from a local pharmacy until a replacement order could be filled by R5's regular pharmacy.

No deficiencies were cited.

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: 04/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/12/2023
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 4
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
02/17/2023 and conducted by Evaluator Shawna Doucette
PUBLIC
COMPLAINT CONTROL NUMBER: 24-AS-20230217092817

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:
04/12/2023
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Griselda "Gracie" Ramirez, Administrator TIME COMPLETED:
01:45 PM
ALLEGATION(S):
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Facility does not have a sufficient supply of PPE
INVESTIGATION FINDINGS:
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The Department investigated the allegation that facility does not have a sufficient supply of PPE and based on observation of PPE supplies, the allegation is unfounded, meaning that the allegation was false, could not have happened, or is without reasonable basis. We have therefore dismissed the complaint.

No deficiency cited.
Unfounded
Estimated Days of Completion:
SUPERVISOR'S NAME: Sergiy PidgirnyTELEPHONE: (559) 246-0610
LICENSING EVALUATOR NAME: Shawna DoucetteTELEPHONE: (559) 580-4595
LICENSING EVALUATOR SIGNATURE:

DATE: 04/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/12/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 4
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
02/17/2023 and conducted by Evaluator Shawna Doucette
PUBLIC
COMPLAINT CONTROL NUMBER: 24-AS-20230217092817

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:
04/12/2023
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Griselda "Gracie" Ramirez, AdministratorTIME COMPLETED:
01:45 PM
ALLEGATION(S):
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2
3
4
5
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7
8
9
Facility is not maintained clean and sanitary
INVESTIGATION FINDINGS:
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The Department investigated the allegation that facility is not maintained clean and sanitary and the complaint is substantiated based on tour of Rooms 239 and 242. The carpets in both rooms were stained and in Room 242, there is a strong smell of urine. It was reported that there are plans to replace the carpet and recliner in Room 242, where R5 resides.


An exit interview was conducted with the Administrator and a copy of this report, plan of correction and appeal rights were provided.
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: 04/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/12/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 24-AS-20230217092817
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: 04/12/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
05/11/2023
Section Cited
CCR
87303
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Maintenance and Operation.The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors.**The carpets in rooms 239 and 242 were stained and in Room 242 is a strong smell of urine.
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Facility will submit a plan of correction by the due date, detailing what was done to either clean or replace the carpets in both rooms and eliminate the odor in room 242. Adm. stated that they are in the process of replacing the carpet and recliner in Room 242. Proof of service and/or replacement will also be submitted.
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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: 04/12/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/12/2023
LIC9099 (FAS) - (06/04)
Page: 4 of 4