157208915-3-2-2022-24-AS-MHON-CCMMED-20220318093231

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 157208915
Report Date: 02/18/2022
Date Signed: 03/02/2022 10:20:36 AM

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
10/12/2021 and conducted by Evaluator Alexandria Walton

PUBLIC

COMPLAINT CONTROL NUMBER: 24-AS-20211012140617

FACILITY NAME:	PALMS AT SAN LAUREN, THE		FACILITY NUMBER:	157208915
ADMINISTRATOR:	RICE, DOUGLAS		FACILITY TYPE:	740
ADDRESS:	5300 HAGEMAN RD		TELEPHONE:	(661) 218-8333
CITY:	BAKERSFIELD	STATE: CA	ZIP CODE:	93308
CAPACITY:	68	CENSUS: 66	DATE:	02/18/2022
		UNANNOUNCED	TIME BEGAN:	10:47 AM
MET WITH:	Administrator, Douglas Rice		TIME COMPLETED:	10:52 AM

ALLEGATION(S):

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Staff do not prevent a resident from wandering while in care

INVESTIGATION FINDINGS:

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This is an amended report.

On 02/18/2022, Licensing Program Analyst (LPA) Walton arrived unannounced to deliver findings on the above allegation. LPA introduced self, stated the purpose of the visit and requested to meet with the Administrator. LPA met with Administrator, Douglas Rice.

Interviews revealed that the Bakersfield Police Department (BPD) were called to the facility due to R1’s aggressiveness towards staff and other residents. Upon BPD’s arrival to the facility, R1 was in the process of being transported to the hospital. Interviews with staff revealed that R1 has “never” left the facility unsupervised. Upon review of records, it was determined that on the date of the event, R1 was not found wandering the outside of the facility.

CONTINUED TO 9099C

Unfounded

Estimated Days of Completion:

SUPERVISOR'S NAME: Melinda Hoffmann	TELEPHONE: (559) 650-7914
LICENSING EVALUATOR NAME: Alexandria Walton	TELEPHONE: (559) 246-0128
LICENSING EVALUATOR SIGNATURE:	DATE: 02/18/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/18/2022

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 24-AS-20211012140617

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: 02/18/2022

NARRATIVE

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This agency has investigated the complaint alleging: Staff do not prevent a resident from wandering while in care. We have found that the complaint was UNFOUNDED, meaning that the allegation was false, could not have happened and/or is without a reasonable basis.

No deficiencies issued during this inspection.

An exit interview was conducted with the Administrator. A copy of this report will be provided via email due to COVID-19 precautionary measures. Facility Representative signature on file.

SUPERVISOR'S NAME: Melinda Hoffmann	TELEPHONE: (559) 650-7914
LICENSING EVALUATOR NAME: Alexandria Walton	TELEPHONE: (559) 246-0128
LICENSING EVALUATOR SIGNATURE:	DATE: 02/18/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/18/2022

LIC9099 (FAS) - (06/04)

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