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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 157206770
Report Date: 09/26/2023
Date Signed: 09/27/2023 06:10:26 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
07/24/2023 and conducted by Evaluator Shawna Doucette
COMPLAINT CONTROL NUMBER: 24-AS-20230724100115
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: 64DATE:
09/26/2023
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH: Assistant Administrator Griselda Gracie RamirezTIME COMPLETED:
02:30 PM
ALLEGATION(S):
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Staff do not properly maintain a resident's room while in care
Staff do not provide a resident with appropriate bedding while in care
Staff do not provide adequate laundry services for a resident
Staff mishandle a resident's medication while in care
Staff are not providing authorized representative access to a resident's records
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Shawna Doucette and Miriam Flores conducted a visit to commence a complaint investigation and deliver findings. LPAs identified themselves and discussed the purpose of the visit and the elements of the allegations with Assistant Administrator, Griselda Gracie Ramirez.

Based on interviews and photos resident's room was not properly maintained. LPA observed dirty carpet and there was an odor of urine. Cited on 24-AS-20230627144600

Based on photos and interviews, facility staff did not put the top sheet on R1's bed. Based on interviews facility staff did not put the protective bed liner on R1's bed.

Based on photos of overflowing laundry basket of soiled bedding, staff did not provide adequate laundry services. Cited on 24-AS-20230627144600

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: 09/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2023
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
07/24/2023 and conducted by Evaluator Shawna Doucette
COMPLAINT CONTROL NUMBER: 24-AS-20230724100115

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: 64DATE:
09/26/2023
UNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH: Assistant Administrator Griselda Gracie RamirezTIME COMPLETED:
02:30 PM
ALLEGATION(S):
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Staff did not prevent a resident from sustaining a pressure injury while in care
Staff do not properly maintain the facility
Staff do not provide comfortable accommodations to the residents
Staff mishandle a resident's heart monitor while in care
Staff are locking a resident's door while in care
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Shawna Doucette and Miriam Flores conducted a visit to commence a complaint investigation and deliver findings. LPAs identified themselves and discussed the purpose of the visit and the elements of the allegations with Assistant Administrator, Griselda Gracie Ramirez.

Based on record review and interviews it was unable to be determined if faciltiy staff were able to prevent R1 from sustaining a pressure injury while in care.

Based record review and interviews, although the carpet has stains facility was able to provide documentation/receipts of professional services and facility maintenance schedule for carpet cleaning and room service.

Based on observations and interviews, there was a window left open to air out odor in R1's room. Per interviews room was around 80 F which does not violate regulations.

Based on record review and interviews, staff have maintained the heart monitored plugged.
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: 09/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2023
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 5
Control Number 24-AS-20230724100115
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: 09/26/2023
NARRATIVE
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Although the heart monitor was unplugged, based on interviews it is undetermined whether or not staff unplugged the heart monitor.

Based on interviews, it is undetermined whether or not staff is locking R1's room.


The Department has investigated the above allegations. Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED.
SUPERVISOR'S NAME: Sergiy PidgirnyTELEPHONE: (559) 246-0610
LICENSING EVALUATOR NAME: Shawna DoucetteTELEPHONE: (559) 580-4595
LICENSING EVALUATOR SIGNATURE:

DATE: 09/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2023
LIC9099 (FAS) - (06/04)
Page: 3 of 5
Control Number 24-AS-20230724100115
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: 09/26/2023
NARRATIVE
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Based on record review, staff did not administer medication on the following dates:
May - 1st, 8th, 9th, 25th, 26th, 27th, 28th, 29th, 30th, and 31st. Cited on 24-AS-20230627144600.

Based on record review, emails, and text messages, staff did not provide authorized representative access to resident's records in a timely manner. Cited on 24-AS-20230627144600


Based on record review, photos, medical records review and interviews, the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division 6, Article 8, and Health and Safety are being cited on the attached LIC 9099D.
SUPERVISOR'S NAME: Sergiy PidgirnyTELEPHONE: (559) 246-0610
LICENSING EVALUATOR NAME: Shawna DoucetteTELEPHONE: (559) 580-4595
LICENSING EVALUATOR SIGNATURE:

DATE: 09/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2023
LIC9099 (FAS) - (06/04)
Page: 4 of 5
Control Number 24-AS-20230724100115
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: 09/26/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/06/2023
Section Cited
CCR
87307(3)(C)
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Clean linen, including blankets, bedspreads, top bed sheets, bottom bed sheets, pillow cases, mattress pads, bath towels, hand towels and wash cloths. The quantity shall be sufficient to permit changing at least once per week or more often when indicated to
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Licensee agrees to submit a written document of understanding of how the facility will meet this regulation by POC due date.
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ensure that clean linen is in use by residents at all times. The linen shall be in good repair...

This requirement was not met as evidence by licensee did not have mattress pads and top sheet on resident's bed which poses a potential health, safety, and/or personal rights risk to resident 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: 09/26/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/26/2023
LIC9099 (FAS) - (06/04)
Page: 5 of 5