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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 157206891
Report Date: 05/26/2022
Date Signed: 05/31/2022 09:54:50 AM

Unsubstantiated


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
05/13/2022 and conducted by Evaluator Lisa Salazar
COMPLAINT CONTROL NUMBER: 24-AS-20220513105541
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: 80DATE:
05/26/2022
UNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Executive Director, Edie CanoTIME COMPLETED:
03:30 PM
ALLEGATION(S):
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Lack of supervision resulting in an altercation between resident’s.
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 records that include staffing schedule that revealed there were 5 staff members on duty for 40 residents in care. SOC341 self reported from the facility and LIC624 (Incident report) states staff observed resident's were walking down the hall way when Resident R1 struck Resident R2.

Records reveal facility immediately reported incident and this complaint was generated as a cross report of the SOC341 that was self reported. LPA observed staffing schedule of staff to 40 residents in care. LPA interviewed staff on shift the date if incident.

Although the allegation may have happened, there is not a preponderance of evident 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: 1 of 2
Control Number 24-AS-20220513105541
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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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: 2 of 2