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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 157206891
Report Date: 10/08/2021
Date Signed: 10/12/2021 10:34:25 AM



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
03/19/2021 and conducted by Evaluator Lisa Salazar
COMPLAINT CONTROL NUMBER: 24-AS-20210319103411
FACILITY NAME:VILLAGE AT SEVEN OAKS ASSISTED LIVING, THEFACILITY NUMBER:
157206891
ADMINISTRATOR:HIDALGO, RICKAYFACILITY TYPE:
740
ADDRESS:4301 BUENA VISTA RDTELEPHONE:
(661) 837-1337
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93311
CAPACITY:128CENSUS: 90DATE:
10/08/2021
UNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Samantha Davidson, Executive Director TIME COMPLETED:
02:45 PM
ALLEGATION(S):
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Resident sustained injuries while in care.
Facility did not seek timely medical treatment.
Facility did not observe changes in resident's health.
Staff are not responding to resident’s call button in a timely manner.

INVESTIGATION FINDINGS:
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On 10/08/2021, Licensing Program Analyst (LPA) L. Salazar arrived at the facility unannounced to deliver findings on the above allegations. LPA was greeted by staff and allowed entry into the facility. COVID 19 precautionary measures were taken at the time of entry. LPA toured the facility inside and out.

During the course of the investigation, LPA conducted interviews and records review of communication logs. Interviews with staff and family reveal the family was notified timely of residents chronic condition. Records review from Emergency Medical Services (EMS) revealed the facility called for EMS assessment even though R1 was refusing treatment. Residents wear individual pendants that have a GPS like system that show their location in the facility. Facility call logs were observed and revealed the time the call button was pressed and what time the call was answered. Logs show the longest time period was 8 minutes. During that period, R1 was in the dining area waiting for assistance to return to their room.

(Continued on 9099-C)
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: 10/08/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/08/2021
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 3
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
03/19/2021 and conducted by Evaluator Lisa Salazar
COMPLAINT CONTROL NUMBER: 24-AS-20210319103411

FACILITY NAME:VILLAGE AT SEVEN OAKS ASSISTED LIVING, THEFACILITY NUMBER:
157206891
ADMINISTRATOR:HIDALGO, RICKAYFACILITY TYPE:
740
ADDRESS:4301 BUENA VISTA RDTELEPHONE:
(661) 837-1337
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93311
CAPACITY:128CENSUS: 90DATE:
10/08/2021
UNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Samantha Davidson, Executive Director TIME COMPLETED:
02:45 PM
ALLEGATION(S):
1
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3
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5
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9
Staff not assisting resident with ADLs.
Staff not administering medication as prescribed.
Resident's room is not being cleaned properly.
INVESTIGATION FINDINGS:
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On 10/08/2021, Licensing Program Analyst (LPA) L. Salazar arrived at the facility unannounced to deliver findings on the above allegations. LPA was greeted by staff and allowed entry into the facility. COVID 19 precautionary measures were taken at the time of entry. LPA toured the facility inside and out.

During the course of the investigation, LPA conducted interviews, records review, and toured the facility. LPA records review revealed Assisted Daily Living (ADL) records indicating pericare is being done after eat toilet use, skin assessments are conducted after each shower. Meals are placed in front of Resident R1'. Facility recently took over R1's Medication management on 03/12/2021 due to change of condition. Completed Medication Administration Record (MAR) was observed. LPA observed facility's daily cleaning logs. LPA observed the facility to be clean and free of debris. Based on the information received, the allegations are UNFOUNDED. Therefore, we have dismissed the complaint. No deficiency was observed. Exit interview conducted.


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: 10/08/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/08/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 3
Control Number 24-AS-20210319103411
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: 10/08/2021
NARRATIVE
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(Continued from 9099)

The Department investigated the above allegations, although the allegations may have happened or are valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegations are UNSUBSTANTIATED.
SUPERVISOR'S NAME: Melinda HoffmannTELEPHONE: (559) -65-7914
LICENSING EVALUATOR NAME: Lisa SalazarTELEPHONE: (559) 691-0004
LICENSING EVALUATOR SIGNATURE:

DATE: 10/08/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/08/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 3