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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 157208915
Report Date: 01/07/2021
Date Signed: 01/07/2021 01:05:34 PM



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
03/24/2020 and conducted by Evaluator Alexandria Walton
COMPLAINT CONTROL NUMBER: 24-AS-20200324101245
FACILITY NAME:PALMS AT SAN LAUREN, THEFACILITY NUMBER:
157208915
ADMINISTRATOR:RICE, DOUGLASFACILITY TYPE:
740
ADDRESS:5300 HAGEMAN RDTELEPHONE:
(661) 218-8333
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93308
CAPACITY:68CENSUS: 45DATE:
01/07/2021
UNANNOUNCEDTIME BEGAN:
11:22 AM
MET WITH:Administrator, Douglas RiceTIME COMPLETED:
01:10 PM
ALLEGATION(S):
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Staff are not incontinence needs of residents.
Staff are not meeting showering needs of residents.
INVESTIGATION FINDINGS:
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On 01/06/2021, Licensing Program Analyst (LPA) A. Walton contacted Administrator, Douglas Rice to deliver findings on the above allegations via telephone due to COVID-19 and precautionary measures. LPA introduced self and discussed the purpose of the call with the Administrator.

LPA conducted interviews with staff. Consistent statements with staff revealed that there are instances when staff will arrive to work to find residents have not been changed for extended periods of time. Interviews also revealed that residents are not receiving showers as scheduled.

Based on interviews with staff, the preponderance of evidence standard has been met, therefore, the above allegations are SUBSTANTIATED.
CONTINUED TO LIC9099-C
Substantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Melinda HoffmannTELEPHONE: (559) 650-7914
LICENSING EVALUATOR NAME: Alexandria WaltonTELEPHONE: (559) 246-0128
LICENSING EVALUATOR SIGNATURE:

DATE: 01/07/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/07/2021
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 6
Control Number 24-AS-20200324101245
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: PALMS AT SAN LAUREN, THE
FACILITY NUMBER: 157208915
VISIT DATE: 01/07/2021
NARRATIVE
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Per California Code of Regulations, Title 22, Division 6, Chapter 8, a deficiency is being cited on the attached 9099-D.

An exit interview was conducted with Administrator and a Plan of Correction was reviewed and developed with Administrator, Douglas Rice. A copy of this report and appeal rights were provided to the Administrator via email and an electronic read receipt confirms receiving these documents. Facility Representative signature on file.
SUPERVISOR'S NAME: Melinda HoffmannTELEPHONE: (559) 650-7914
LICENSING EVALUATOR NAME: Alexandria WaltonTELEPHONE: (559) 246-0128
LICENSING EVALUATOR SIGNATURE:

DATE: 01/07/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/07/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 6
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
03/24/2020 and conducted by Evaluator Alexandria Walton
PUBLIC
COMPLAINT CONTROL NUMBER: 24-AS-20200324101245

FACILITY NAME:PALMS AT SAN LAUREN, THEFACILITY NUMBER:
157208915
ADMINISTRATOR:RICE, DOUGLASFACILITY TYPE:
740
ADDRESS:5300 HAGEMAN RDTELEPHONE:
(661) 218-8333
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93308
CAPACITY:68CENSUS: 45DATE:
01/07/2021
UNANNOUNCEDTIME BEGAN:
11:22 AM
MET WITH:Administrator, Douglas RiceTIME COMPLETED:
01:10 PM
ALLEGATION(S):
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Staff handled residents in a rough manner
Residents have sustained injuries while in care
Staff are not meeting supervision needs of residents
Staff are not providing food in the quantity to meet the needs of the residents
INVESTIGATION FINDINGS:
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On 01/06/2021, Licensing Program Analyst (LPA) A. Walton contacted Administrator, Douglas Rice to deliver findings on the above allegations via telephone due to COVID-19 and precautionary measures. LPA introduced self and discussed the purpose of the call with the Administrator.

The Department has investigated the above allegations. Based on interviews and facility tour, the above allegations are UNSUBSTANTIATED. Although the allegations may have happened or is valid, there is not a preponderance of evidence to prove the allegations did or did not occur.

No deficiencies issued. An exit interview was conducted with Administrator. A copy of the report was discussed and provided to Administrator, Douglas Rice via email and an electronic read receipt confirms receiving this document. Facility Representative signature on file.

Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Melinda HoffmannTELEPHONE: (559) 650-7914
LICENSING EVALUATOR NAME: Alexandria WaltonTELEPHONE: (559) 246-0128
LICENSING EVALUATOR SIGNATURE:

DATE: 01/07/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/07/2021
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 6
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
03/24/2020 and conducted by Evaluator Alexandria Walton
PUBLIC
COMPLAINT CONTROL NUMBER: 24-AS-20200324101245

FACILITY NAME:PALMS AT SAN LAUREN, THEFACILITY NUMBER:
157208915
ADMINISTRATOR:RICE, DOUGLASFACILITY TYPE:
740
ADDRESS:5300 HAGEMAN RDTELEPHONE:
(661) 218-8333
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93308
CAPACITY:68CENSUS: 45DATE:
01/07/2021
UNANNOUNCEDTIME BEGAN:
11:22 AM
MET WITH:Administrator, Douglas RiceTIME COMPLETED:
01:10 PM
ALLEGATION(S):
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Facility has ants.
INVESTIGATION FINDINGS:
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On 01/06/2021, Licensing Program Analyst (LPA) A. Walton contacted Administrator, Douglas Rice to deliver findings on the above allegation via telephone due to COVID-19 and precautionary measures. LPA introduced self and discussed the purpose of the call with the Administrator.

LPA conducted interviews and reviewed records.

The above facility has ongiong monthly pest control service. Reciepts for proof of service were provided during the complaint investigation.

This agency has investigated the complaint alleging: Facility has ants. We have found that the complaint was UNFOUNDED.
Unfounded
Estimated Days of Completion:
SUPERVISOR'S NAME: Melinda HoffmannTELEPHONE: (559) 650-7914
LICENSING EVALUATOR NAME: Alexandria WaltonTELEPHONE: (559) 246-0128
LICENSING EVALUATOR SIGNATURE:

DATE: 01/07/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/07/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 4 of 6
Control Number 24-AS-20200324101245
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: PALMS AT SAN LAUREN, THE
FACILITY NUMBER: 157208915
VISIT DATE: 01/07/2021
NARRATIVE
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No deficiencies issued.

An exit interview was conducted with Administrator, Douglas Rice. A copy of this report was discussed and provided to Administrator via email and an electronic read receipt confirms receiving these documents. Facility Representative signature on file.
SUPERVISOR'S NAME: Melinda HoffmannTELEPHONE: (559) 650-7914
LICENSING EVALUATOR NAME: Alexandria WaltonTELEPHONE: (559) 246-0128
LICENSING EVALUATOR SIGNATURE:

DATE: 01/07/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/07/2021
LIC9099 (FAS) - (06/04)
Page: 5 of 6
Control Number 24-AS-20200324101245
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: PALMS AT SAN LAUREN, THE
FACILITY NUMBER: 157208915
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/07/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
01/11/2021
Section Cited
CCR
87468.1(a)(2)
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87468.1 Personal Rights of Residents in All Facilities:(a) Residents...shall have all of the following personal rights:(2) To be accorded safe, healthful and comfortable accommodations, furnishings and equipment.
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By 1/11/2021, Administrator will submit a plan detailing what facility willl do to ensure residents are showered as scheduled and changed in a timely manner. Administrator will conduct an In Service for staff...
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This requirement was not met as evidenced by: Residents being left unchanged for extended periods of time and Residents did not receive showers as scheduled. This poses an immediate health and safety risk to residents in care.
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Training topics and attendance will be submitted to the Fresno CCL office by 2/8/2021.
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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.
SUPERVISOR'S NAME: Melinda HoffmannTELEPHONE: (559) 650-7914
LICENSING EVALUATOR NAME: Alexandria WaltonTELEPHONE: (559) 246-0128
LICENSING EVALUATOR SIGNATURE:

DATE: 01/07/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/07/2021
LIC9099 (FAS) - (06/04)
Page: 6 of 6