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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157206891
Report Date: 10/24/2022
Date Signed: 10/25/2022 08:27:35 AM


Document Has Been Signed on 10/25/2022 08:27 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:JENKINS, KRYSTALFACILITY TYPE:
740
ADDRESS:4301 BUENA VISTA RDTELEPHONE:
(661) 837-1337
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93311
CAPACITY:128CENSUS: 74DATE:
10/24/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:03 PM
MET WITH:Krystal Jenkins ,Executive Director Specialist and Annette Eggleston, Health Service Director TIME COMPLETED:
02:00 PM
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On 10/24/22, Licensing Program Analysts (LPAs) M. Yang and A. Walton arrived at the facility unannounced to conduct a case management visit based on record review of incident report submitted. LPAs was greeted by Krystal Jenkins ,Executive Director Specialist (EDS) and Annette Eggleston, Health Service Director (HSD), stated the purpose of the visit and was allowed entry into the facility.

LPAs discuss two incident report that was received by the department. One report the facility reported incident that occurred on 09/29/22 where Resident (R1) eloped from the memory care unit and were observed alone and unattended outside of the facility premise. The resident was redirected back into the facility. Interview with HSD who stated staff immediately respond to exit alarm and observed resident in the Memory Care lobby. Resident was redirected back into the Memory Care area.

The second report was received on 10/19/22, the facility report incident occurred on 10/17/22 where Resident 2 (R2) and Resident 3 (R3) was located outside the facility. At approximately 05:35 PM exit alarm was activated, staff immediately located R3 outside exit door 4. R2 was located on the community premise by the community Dog park and redirected back into the facility.

The information provide will be reviewed; a follow up case management will be conducted if necessary.

An exit interview conducted. Due to technically issues, LPA is unable to print report. A copy of this report will be emailed to Regional Executive Director Specialist for signature. Signed report on file.

SUPERVISOR'S NAME: Melinda HoffmannTELEPHONE: (559) 341-3274
LICENSING EVALUATOR NAME: Mai YangTELEPHONE: 559-772-7402
LICENSING EVALUATOR SIGNATURE:
DATE: 10/24/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/24/2022
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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