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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157206770
Report Date: 03/11/2025
Date Signed: 03/11/2025 05:43:43 PM

Document Has Been Signed on 03/11/2025 05:43 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
FRESNO RO, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME:POINTE AT SUMMIT HILLS, THEFACILITY NUMBER:
157206770
ADMINISTRATOR/
DIRECTOR:		PERLA PENAFACILITY TYPE:
740
ADDRESS:4501 UPLAND POINT DRIVETELEPHONE:
(661) 447-4800
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93306
CAPACITY: 170TOTAL ENROLLED CHILDREN: 0CENSUS: 81DATE:
03/11/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:53 AM
MET WITH:Administrator Perla PenaTIME VISIT/
INSPECTION COMPLETED:
06:00 PM
NARRATIVE
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Licensing Program Analysts (LPA)'s Shawna Doucette arrived at the facility unannounced to conduct the Required Annual Inspection. LPA met with Administrator Perla Pena.

A tour of the facility was conducted with the Administrator.

LPA Doucette observed 8 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 playing pool in AL. Residents in MC were eating dinner.

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 3/20/24. Fire drill was last conducted 1/13/25.

There was outdoor seating for the residents.

Resident, medication and staff records were reviewed. LPA conducted a pill count of Vitamin B12. The over the counter pill bottle contained 120 pills and started on 12/1/24. R3's B12 medication had 5 pills left and should have had 19 pills left. R3's Ibuprofen had two separate over the counter bottles open. One container contained brown round pills and brown oblong pills. LPA took photos. 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.

Alexandria WaltonTELEPHONE: (559) 246-0128
Shawna DoucetteTELEPHONE: (559) 580-4595
DATE: 03/11/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/11/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 4
Document Has Been Signed on 03/11/2025 05:43 PM - It Cannot Be Edited


Created By: Shawna Doucette On 03/11/2025 at 05:22 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1314 E SHAW AVE
FRESNO, CA 93710

FACILITY NAME: POINTE AT SUMMIT HILLS, THE
FACILITY NUMBER: 157206770

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/11/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
87465(a)(4)
Incidental Medical and Dental Care Services
(4) The licensee shall assist residents with self-administered medications as needed.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above in R3's B12 over the counter pill bottle contained 120 pills and started on 12/1/24. R3's B12 medication had 5 pills left and should have had 19 pills left, which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 03/12/2025
Plan of Correction
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Licensee agrees to conduct a staff training on medication and will submit an agenda and date of training by POC due date 03/12/25. Licensee agrees to submit certificates of staff who were trained 3 days after the training date.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Alexandria Walton
TELEPHONE: (559) 246-0128
LICENSING EVALUATOR NAME:Shawna Doucette
TELEPHONE: (559) 580-4595
LICENSING EVALUATOR SIGNATURE:
DATE: 03/11/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/11/2025


LIC809 (FAS) - (06/04)
Page: 2 of 4
Document Has Been Signed on 03/11/2025 05:43 PM - It Cannot Be Edited


Created By: Shawna Doucette On 03/11/2025 at 05:22 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1314 E SHAW AVE
FRESNO, CA 93710

FACILITY NAME: POINTE AT SUMMIT HILLS, THE
FACILITY NUMBER: 157206770

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/11/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
87465(h)(5)
Incidental Medical and Dental Care Services
(h) The following requirements shall apply to medications which are centrally stored: (5) Each resident's medication shall be stored in its originally received container. No medications shall be transferred between containers.

This requirement is not met as evidenced by:
Deficient Practice Statement
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4
Based on [(observation) (interview) (record review)], the licensee did not comply with the section cited above in R3's Ibuprofen had two separate over the counter bottles open. One container contained brown round pills and brown oblong pills, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/12/2025
Plan of Correction
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Licensee agrees to destroy medications that were in the same container and conduct staff training to meet this regulation
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Alexandria Walton
TELEPHONE: (559) 246-0128
LICENSING EVALUATOR NAME:Shawna Doucette
TELEPHONE: (559) 580-4595
LICENSING EVALUATOR SIGNATURE:
DATE: 03/11/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/11/2025


LIC809 (FAS) - (06/04)
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