157206891-11-18-2022-24-AS-MHON-CLVPMS-20221207102647

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 157206891
Report Date: 11/18/2022
Date Signed: 11/18/2022 10:24:40 AM

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
07/19/2022 and conducted by Evaluator Mai Yang

PUBLIC

COMPLAINT CONTROL NUMBER: 24-AS-20220719112623

FACILITY NAME:	VILLAGE AT SEVEN OAKS ASSISTED LIVING, THE		FACILITY NUMBER:	157206891
ADMINISTRATOR:	OSORIO, JULIUS		FACILITY TYPE:	740
ADDRESS:	4301 BUENA VISTA RD		TELEPHONE:	(661) 837-1337
CITY:	BAKERSFIELD	STATE: CA	ZIP CODE:	93311
CAPACITY:	128	CENSUS: 67	DATE:	11/18/2022
		UNANNOUNCED	TIME BEGAN:	09:54 AM
MET WITH:	Krystal Jenkins ,Executive Director Specialist, Pamela Bradley, Exectuive Director and Annette Eggleston, Health Service Director		TIME COMPLETED:	10:45 AM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Resident was left unattended outside in heat for extended period of time

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

On 11/18/22, Licensing Program Analysts (LPAs), M. Yang and A. Walton, arrived at the facility unannounced to deliver complaint finding, and stated the purpose of the visit. LPAs were greeted by Krystal Jenkins ,Executive Director Specialist (EDS), Pamela Bradley, Exectuive Director (ED) and Annette Eggleston, Health Service Director (HSD).

During the course of the investigation, the Department conducted interviews and reviewed records and based on review, the preponderance of evidence standard has been met, therefore the allegation that Resident #1 (R1) was left unattended outside in the heat for an extended period of time is SUBSTANTIATED. Per California Code of Regulations, Title 22, Division 6, Chapter 8, a deficiency is being cited on the attached 9099-D. As a result of the incident, R1 sustained serious bodily injuries; a violation that warrants a civil penalty assessment. At this time, the civil penalty assessment is under review, and a civil penalty determination is pending by the Department. Once the civil penalty assessment has been determined, an LPA(s) will return to assess the civil penalty, or a meeting will be scheduled at the licensing office. Exit interview was conducted and a Plan of Correction was reviewed and developed with Executive Director Specialist. A copy of this report and appeal rights were given to Executive Director Specialist, whose signature confirms receipt of this report.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Melinda Hoffmann	TELEPHONE: (559) 341-3274
LICENSING EVALUATOR NAME: Mai Yang	TELEPHONE: 559-772-7402
LICENSING EVALUATOR SIGNATURE:	DATE: 11/18/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/18/2022

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 3

Control Number 24-AS-20220719112623

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: 11/18/2022

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 11/19/2022 Section Cited CCR 87468.2(a)(4)	1 2 3 4 5 6 7	Additional Personal Rights of Residents in Privately Operated Facilities In addition to the rights listed in Section 87468.1, Personal Rights of Residents in All Facilities, residents in privately operated residential care facilities for the elderly...(4) To care, supervision, and services that meet their individual needs and are delivered by staff that are sufficient in numbers, qualifications, and competency to meet their needs. This requirement was not met:	1 2 3 4 5 6 7	The Licensee will submit plan of correction detailing steps the facility will take to ensure regulations are met by the due date.
	8 9 10 11 12 13 14	This requirement was not met as evidenced by R1 being left outside in the heat for an extended period of time on 7/16/22, resulting in serious bodily injury.	8 9 10 11 12 13 14	Plan will include documentation of trainings and rooster of staff attendance.
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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 Hoffmann	TELEPHONE: (559) 341-3274
LICENSING EVALUATOR NAME: Mai Yang	TELEPHONE: 559-772-7402
LICENSING EVALUATOR SIGNATURE:	DATE: 11/18/2022

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/18/2022

LIC9099 (FAS) - (06/04)

Page: 2 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
07/19/2022 and conducted by Evaluator Mai Yang

PUBLIC

COMPLAINT CONTROL NUMBER: 24-AS-20220719112623

FACILITY NAME:	VILLAGE AT SEVEN OAKS ASSISTED LIVING, THE		FACILITY NUMBER:	157206891
ADMINISTRATOR:	OSORIO, JULIUS		FACILITY TYPE:	740
ADDRESS:	4301 BUENA VISTA RD		TELEPHONE:	(661) 837-1337
CITY:	BAKERSFIELD	STATE: CA	ZIP CODE:	93311
CAPACITY:	128	CENSUS: 67	DATE:	11/18/2022
		UNANNOUNCED	TIME BEGAN:	09:54 AM
MET WITH:	Krystal Jenkins ,Executive Director Specialist, Pamela Bradley, Exectuive Director and Annette Eggleston, Health Service Director		TIME COMPLETED:	10:45 AM

ALLEGATION(S):

1
2
3
4
5
6
7
8
9

Questionable death

INVESTIGATION FINDINGS:

1
2
3
4
5
6
7
8
9
10
11
12
13

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Melinda Hoffmann	TELEPHONE: (559) 341-3274
LICENSING EVALUATOR NAME: Mai Yang	TELEPHONE: 559-772-7402
LICENSING EVALUATOR SIGNATURE:	DATE: 11/18/2022

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/18/2022

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