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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157206891
Report Date: 03/14/2022
Date Signed: 03/14/2022 03:23:16 PM


Document Has Been Signed on 03/14/2022 03:23 PM - 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:GARZA-DAVIDSON, SAMANTHAFACILITY TYPE:
740
ADDRESS:4301 BUENA VISTA RDTELEPHONE:
(661) 837-1337
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93311
CAPACITY:128CENSUS: 40DATE:
03/14/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
02:15 PM
MET WITH:Samantha Davison, Executive DirectorTIME COMPLETED:
03:20 PM
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Licensing Program Analysts (LPA's) L. Salazar and L. Cabrera arrived unannounced to conduct a Case Management visit. LPA's met with Samantha Davidson, Executive Director Trevin Willis, Memory Care Director and Edie Cano, Health Services Director and announced the purpose of the visit.

LPA's conducted interviews and requested documentation in regards to Resident (R1) incident reports that occurred in January, February and March 2022. LPA Salazar requested incident reports and confirmations to be submitted by Friday, 3/18/22.

No deficiencies were cited during the inspection. A copy of the report was provided.
SUPERVISOR'S NAME: Sergiy PidgirnyTELEPHONE: (559) 650-7923
LICENSING EVALUATOR NAME: Lady CabreraTELEPHONE: (559) 243-8080
LICENSING EVALUATOR SIGNATURE:
DATE: 03/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/14/2022
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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