157206770-4-24-2024-24-AS-SDOE-D4MS3T-20240424133141

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 157206770
Report Date: 04/24/2024
Date Signed: 04/24/2024 01:31:53 PM

Document Has Been Signed on 04/24/2024 01:31 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, THE		FACILITY NUMBER:	157206770
ADMINISTRATOR:	PERLA PENA		FACILITY TYPE:	740
ADDRESS:	4501 UPLAND POINT DRIVE		TELEPHONE:	(661) 447-4800
CITY:	BAKERSFIELD	STATE: CA	ZIP CODE:	93306
CAPACITY:	102	CENSUS: 60	DATE:	04/24/2024
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	08:32 AM
MET WITH:	Administrator Perla Pena		TIME COMPLETED:	01:30 PM

NARRATIVE

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Licensing Program Analysts (LPA)'s Shawna Doucette and Darius Williams arrived at the facility unannounced to conduct the Required Annual Inspection. LPA met with Administrator Perla Pena. LPA disclosed the purpose of the inspection and was granted entry into the facility by the Administrator.

A tour of the facility was conducted with the Administrator.

LPA Doucette observed 6 resident apartments. Residents' apartments were toured and inspected and observed to be clean. Hot water temperature was measured from 116 to 119.7 F. Residents were observed to be participating in activities. Residents were doing a bible study in AL and residents were doing exercises in MC.

Kitchen toured, supply of food observed and food stored properly for perishable and nonperishable. Medications were stored in a locked Medication cart and in a locked medication room. Cleaning supplies were in a locked storage closet. Facility has a pull station fire alarm and a fire panel and sprinkler system. Fire extinguishers were charged and had service dates of 5/09/23.

There was outdoor seating for the residents.

Resident, medication and staff records were reviewed. R5 did not have a home health care plan. Current first aid and CPR were on file for staff.

See attached 809D.

An exit interview was conducted with the Administrator. A copy of this report, plan of correction and appeal rights were provided.

SUPERVISOR'S NAME: Sergiy Pidgirny	TELEPHONE: (559) 246-0610
LICENSING EVALUATOR NAME: Shawna Doucette	TELEPHONE: (559) 580-4595
LICENSING EVALUATOR SIGNATURE:	DATE: 04/24/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/24/2024

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 04/24/2024 01:31 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: 04/24/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

87609(b)(4)

Allowable Health Conditions and the Use of Home Health Agencies

(b) Incidental medical care may be provided to residents through a licensed home health agency provided the following conditions are met: (4) The licensee and home health agency agree in writing on the responsibilities of the home health agency, and those of the licensee in caring for the resident's medical condition(s). This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on record review, the licensee did not comply with the section cited above in Licensee did not have a written Home Health Care plan agreement identifying the responsibilities of care for R5, which poses/posed a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 04/26/2024
	Plan of Correction
1 2 3 4	Licensee agrees to obtain a written agreement identifying the responsibilities of facility staff and the home health care agency and submit to Licensing by POC due date 4/26/24.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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 Pidgirny	TELEPHONE: (559) 246-0610
LICENSING EVALUATOR NAME: Shawna Doucette	TELEPHONE: (559) 580-4595
LICENSING EVALUATOR SIGNATURE:	DATE: 04/24/2024

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/24/2024

LIC809 (FAS) - (06/04)

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