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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157206891
Report Date: 06/21/2022
Date Signed: 06/21/2022 11:39:56 AM


Document Has Been Signed on 06/21/2022 11:39 AM - 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:VILLAGE AT SEVEN OAKS ASSISTED LIVING, THEFACILITY NUMBER:
157206891
ADMINISTRATOR:CANO, EDIEFACILITY TYPE:
740
ADDRESS:4301 BUENA VISTA RDTELEPHONE:
(661) 837-1337
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93311
CAPACITY:128CENSUS: DATE:
06/21/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Julius Osorio, Operations Specialist TIME COMPLETED:
12:00 PM
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On 06/21/2022, Licensing Program Analyst (LPA) L. Salazar arrived at the facility unannounced to conduct a case management inspection based on a self reporting by facility. LPA was greeted by Operations Specialist, stated the purpose of the visit and was allowed entry into the facility. COVID precautionary measures were taken at the time of entry.

On 06/17/2022, the facility self reported an alleged incident, based on verbal statements made by another employee. LPA reviewed and obtained copy of Staff S1's file which revealed staff was hired in March of 2022 and does not have the required Dementia training hours per regulation.

LPA conducted interviews with staff, which revealed no evidence supporting the allegation made. Facility is currently conducting an internal investigation and will provide LPA with finalized report.

Based on today’s visit, a deficiency is being cited, per California Code of Regulations, Title 22, Division 6, Chapter 8 on the attached 809D.

An exit interview was conducted with Operations Specialist and a copy of this report was provided. A plan of correction was developed and reviewed with LPA.

SUPERVISOR'S NAME: Melinda HoffmannTELEPHONE: (559) 341-3274
LICENSING EVALUATOR NAME: Lisa SalazarTELEPHONE: (559) 691-0004
LICENSING EVALUATOR SIGNATURE:
DATE: 06/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/21/2022
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 06/21/2022 11:39 AM - 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: VILLAGE AT SEVEN OAKS ASSISTED LIVING, THE
FACILITY NUMBER: 157206891

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/21/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
07/15/2022
Section Cited

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87707 Training Requirements If Advertising Dementia Special Care, Programming And/Or Environments
(a) Licensees who advertise, promote, or otherwise hold themselves out as providing special care, programming, and/or environments for residents with dementia or related disorders shall ensure that all direct care staff, described in Section 87706(a)(1), who provide care to residents with dementia, meet the following training requirements:
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This requirement was not met as evidenced by LPA's observation of Staff S1's training records. Records indicate Staff S1 received 1(one) hour of training in Dementia care at the time of hire in March 2022.
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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: Melinda HoffmannTELEPHONE: (559) 341-3274
LICENSING EVALUATOR NAME: Lisa SalazarTELEPHONE: (559) 691-0004
LICENSING EVALUATOR SIGNATURE:
DATE: 06/21/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/21/2022
LIC809 (FAS) - (06/04)
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