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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 157206891
Report Date: 05/26/2022
Date Signed: 05/26/2022 03:48:45 PM

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
02/02/2022 and conducted by Evaluator Lisa Salazar
COMPLAINT CONTROL NUMBER: 24-AS-20220202135853
FACILITY NAME:VILLAGE AT SEVEN OAKS ASSISTED LIVING, THEFACILITY NUMBER:
157206891
ADMINISTRATOR:GARZA-DAVIDSON, SAMANTHAFACILITY TYPE:
740
ADDRESS:4301 BUENA VISTA RDTELEPHONE:
(661) 837-1337
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93311
CAPACITY:128CENSUS: 80DATE:
05/26/2022
UNANNOUNCEDTIME BEGAN:
11:24 AM
MET WITH:Administrator Edie CanoTIME COMPLETED:
01:45 PM
ALLEGATION(S):
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Facility increased rent without proper notice.
INVESTIGATION FINDINGS:
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On 05/26/2022, Licensing Program Analyst (LPA) L. Salazar arrived the facility unannounced to deliver findings on the above complaint allegations. LPA was greeted by Administrator, stated the purpose of the visit and was allowed entry into the facility. COVID precautionary measures were taken at the time of entry.

During the investigation, LPA reviewed resident and facility records and conducted interview with current Executive Director. Records review revealed, previous Executive Director did not have documentation that rent increase notice was given to Responsible Party in a timely manner.

Based on the: LPA’s observation of facility's rate increase noticed dated 12/2021, the preponderance of evidence standard has been met; therefore, the above allegation is found to be substantiated. Per California Code of Regulations, Title 22, Division 6, Chapter 8, a deficiency is being cited on the attached 9099-D.

(continued on 9099-C)
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Melinda HoffmannTELEPHONE: (559) -65-7914
LICENSING EVALUATOR NAME: Lisa SalazarTELEPHONE: (559) 691-0004
LICENSING EVALUATOR SIGNATURE:

DATE: 05/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/26/2022
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
Control Number 24-AS-20220202135853
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: VILLAGE AT SEVEN OAKS ASSISTED LIVING, THE
FACILITY NUMBER: 157206891
VISIT DATE: 05/26/2022
NARRATIVE
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(Continued from 9099)

An exit interview was conducted with Administrator and a plan of correction was developed by Administrator and reviewed with LPA. A copy of this report along with appeal rights were discussed and provided .
SUPERVISOR'S NAME: Melinda HoffmannTELEPHONE: (559) -65-7914
LICENSING EVALUATOR NAME: Lisa SalazarTELEPHONE: (559) 691-0004
LICENSING EVALUATOR SIGNATURE:

DATE: 05/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/26/2022
LIC9099 (FAS) - (06/04)
Page: 5 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
02/02/2022 and conducted by Evaluator Lisa Salazar
COMPLAINT CONTROL NUMBER: 24-AS-20220202135853

FACILITY NAME:VILLAGE AT SEVEN OAKS ASSISTED LIVING, THEFACILITY NUMBER:
157206891
ADMINISTRATOR:GARZA-DAVIDSON, SAMANTHAFACILITY TYPE:
740
ADDRESS:4301 BUENA VISTA RDTELEPHONE:
(661) 837-1337
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93311
CAPACITY:128CENSUS: 80DATE:
05/26/2022
UNANNOUNCEDTIME BEGAN:
11:24 AM
MET WITH:Administrator Edie CanoTIME COMPLETED:
01:45 PM
ALLEGATION(S):
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Resident missed medical appointments.
Resident's hygiene is not being met.
.

INVESTIGATION FINDINGS:
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On 05/26/2022, Licensing Program Analyst (LPA) L. Salazar arrived the facility unannounced to deliver findings on the above complaint allegations. LPA was greeted by Administrator, stated the purpose of the visit and was allowed entry into the facility. COVID precautionary measures were taken at the time of entry.

During the investigation, LPA toured the memory care unit, reviewed resident and facility records and conducted interviews. Records review reveal Resident R1 has refused medical treatment on multiple occasions. Facility has documented and contacted physician. R1, who has the capacity for self-care which includes showers, is scheduled twice a week for showers.

Although the allegation may have happened, there is not a preponderance of evidence to prove that the alleged violation occurred, therefore the allegation is unsubstantiated. Exit interview conducted and copy of report was left with licensee.
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Melinda HoffmannTELEPHONE: (559) -65-7914
LICENSING EVALUATOR NAME: Lisa SalazarTELEPHONE: (559) 691-0004
LICENSING EVALUATOR SIGNATURE:

DATE: 05/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/26/2022
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-20220202135853
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: VILLAGE AT SEVEN OAKS ASSISTED LIVING, THE
FACILITY NUMBER: 157206891
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/26/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
06/03/2022
Section Cited
HSC
1569.625
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Health and Safety Code section 1569.655 provides:
(a) If a licensee of a residential care facility for the elderly increases the rates of fees for residents or makes increases in any of its rate structures for services, the licensee shall provide no less than 60 days' prior written notice to the residents or the residents' representatives setting forth the amount of the increase, the reason for the increase, and a general description of the additional costs, except for an increase in the rate due to a change in the level of care of the resident...
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Prior Adminsitrator contacted responsible party for R1 and removed the increase due to hardship 02/2022. Current Adminsitrator will provide LPA with a signed copy of the regulation, evidencing Administrator understands the regulation. ** POC cleared**
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This requirement was not met as evidenced by LPA’s observation of rate increase letter sent to Responsible party dated December 2021, which is not a 60 day notice. This poses a potential risk to residents 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: Melinda HoffmannTELEPHONE: (559) -65-7914
LICENSING EVALUATOR NAME: Lisa SalazarTELEPHONE: (559) 691-0004
LICENSING EVALUATOR SIGNATURE:

DATE: 05/26/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/26/2022
LIC9099 (FAS) - (06/04)
Page: 3 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
02/02/2022 and conducted by Evaluator Lisa Salazar
COMPLAINT CONTROL NUMBER: 24-AS-20220202135853

FACILITY NAME:VILLAGE AT SEVEN OAKS ASSISTED LIVING, THEFACILITY NUMBER:
157206891
ADMINISTRATOR:GARZA-DAVIDSON, SAMANTHAFACILITY TYPE:
740
ADDRESS:4301 BUENA VISTA RDTELEPHONE:
(661) 837-1337
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93311
CAPACITY:128CENSUS: 80DATE:
05/26/2022
UNANNOUNCEDTIME BEGAN:
11:24 AM
MET WITH:Adminsitrator Edie CanoTIME COMPLETED:
01:45 PM
ALLEGATION(S):
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Staff are mismanaging resident's medication.
Staff did not safeguard resident's personal items.
Resident is not provided clean linen
INVESTIGATION FINDINGS:
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On 05/26/2022, Licensing Program Analyst (LPA) L. Salazar arrived the facility unannounced to deliver findings on the above complaint allegations. LPA was greeted by Administator, stated the purpose of the visit and was allowed entry into the facility. COVID precautionary measures were taken at the time of entry.

During the investigation, LPA toured the memory care unit, reviewed resident and facility records and conducted interviews. Records review reveal Resident R1 has refused medications on multiple occasions and has the personal right to do so. Facility has documented and contacted physician per regulation. No LIC 621 (CLIENT/RESIDENT PERSONAL PROPERTY AND VALUABLES) observed in file for R1.

We have found that the complaint was unfounded, meaning that the allegation is false, could not have happened and or is without reasonable basis.
Unfounded
Estimated Days of Completion:
SUPERVISOR'S NAME: Melinda HoffmannTELEPHONE: (559) -65-7914
LICENSING EVALUATOR NAME: Lisa SalazarTELEPHONE: (559) 691-0004
LICENSING EVALUATOR SIGNATURE:

DATE: 05/26/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/26/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 5