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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157206891
Report Date: 12/03/2021
Date Signed: 12/29/2021 11:33:27 AM

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:GARZA-DAVIDSON, SAMANTHAFACILITY TYPE:
740
ADDRESS:4301 BUENA VISTA RDTELEPHONE:
(661) 837-1337
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93311
CAPACITY:128CENSUS: 80DATE:
12/03/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
01:45 PM
MET WITH:Samantha Davidson, Executive Director TIME COMPLETED:
02:42 PM
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On 12/03/21, Licensing Program Analyst (LPA) L. Salazar arrived at the facility unannounced to conducts interviews with staff members that witnessed the allegations made on complaint control # 24-AS-20211123112944. LPA was greeted at the door by receptionist. COVID19 precautionary measures were taken prior to LPA's entry. LPA toured the facility with Executive Director. LPA stated the purpose of visit was to conduct interviews the Executive Director and staff.

LPA interviewed Memory Care Director (MCD) and Staff S1. LPA obtained contact information for all staff on shift the evening of the incident. LPA will return at a later date to deliver findings on the above complaint.

Exit interview conducted. No deficiencies cited on today's visit.
SUPERVISOR'S NAME: Melinda HoffmannTELEPHONE: (559) -65-7914
LICENSING EVALUATOR NAME: Lisa SalazarTELEPHONE: (559) 691-0004
LICENSING EVALUATOR SIGNATURE:

DATE: 12/03/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/03/2021
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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