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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 157206898
Report Date: 02/28/2022
Date Signed: 02/28/2022 10:41:33 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
02/18/2022 and conducted by Evaluator Shawna Doucette
COMPLAINT CONTROL NUMBER: 24-AS-20220218085552
FACILITY NAME:SPRUCE GARDENSFACILITY NUMBER:
157206898
ADMINISTRATOR:PONCE, BEATRIZ AFACILITY TYPE:
740
ADDRESS:13303 NANTUCKET PLACETELEPHONE:
(661) 829-2703
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93314
CAPACITY:6CENSUS: 3DATE:
02/28/2022
UNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Administrator Stephanie HaroTIME COMPLETED:
10:45 AM
ALLEGATION(S):
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Staff are not properly trained and does not have CPR/1st Aide training
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPA)'s Shawna Doucette and Lisa Salazar contacted the facility to commence a complaint investigation. LPA's conducted a visit and took COVID-19 pre-cautionary measures. LPAs identified themselves and explained the purpose of the visit was to deliver findings to Administrator Stephanie Haro.

LPA conducted interviews and reviewed records which showed the facility does not have CPR/First Aid training for S1 and S2.

Based on LPAs observations and interviews which were conducted and record review, the preponderance of evidence standard has been met, therefore the above allegations are found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division & Chapter number, are being cited on the attached LIC 9099D.

Plan of correction and appeal rights was reviewed with the Administrator. An exit interview was conducted and a copy of this report was provided via email.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Sergiy Pidgirny
LICENSING EVALUATOR NAME: Shawna Doucette
LICENSING EVALUATOR SIGNATURE:

DATE: 02/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/28/2022
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 2
Control Number 24-AS-20220218085552
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: SPRUCE GARDENS
FACILITY NUMBER: 157206898
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/28/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/30/2022
Section Cited
CCR
87411(c)(1)
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87411 Personnel Requirements - General(c) All RCFE staff who assist residents with personal activities of daily living shall receive initial and annual training as specified in Health and Safety Code sections 1569.625 and 1569.69 (1) Staff providing care shall receive appropriate training in first aid from persons
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Plan of Correction POC Licensee agrees to provide proof of first aid training for S1 and S2 by POC due date.
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qualified by such agencies as the American Red Cross. Based on interviews, observation and review of records S1 and S2 did not have first aid trainined which poses a potential Health, Safety or personal rights risk to the residents in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISORS NAME: Sergiy Pidgirny
LICENSING EVALUATOR NAME: Shawna Doucette
LICENSING EVALUATOR SIGNATURE:

DATE: 02/28/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/28/2022
LIC9099 (FAS) - (06/04)
Page: 2 of 2