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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 157209136
Report Date: 10/20/2021
Date Signed: 10/20/2021 12:52:19 PM

Unfounded


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
09/30/2021 and conducted by Evaluator Lady Cabrera
COMPLAINT CONTROL NUMBER: 24-AS-20210930171438
FACILITY NAME:REDWOOD SENIOR LIVING BAKERSFIELDFACILITY NUMBER:
157209136
ADMINISTRATOR:ESPINAL, KENNYFACILITY TYPE:
740
ADDRESS:810 S UNION AVETELEPHONE:
(415) 810-0145
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93307
CAPACITY:41CENSUS: 39DATE:
10/20/2021
UNANNOUNCEDTIME BEGAN:
12:35 PM
MET WITH:Anthony Barbato, LicenseeTIME COMPLETED:
01:10 PM
ALLEGATION(S):
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Facility is charging resident for services not provided.
Staff are not administering medication(s) to resident according to physician's orders.
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Lady Cabrera conducted the complaint investigation visit to the facility. LPA met with Licensee to deliver the findings of the complaint.

During the course of this investigation, LPA interviewed facility staff, resident (R1) and PACE Program Staff. It was determined that the above allegations: Facility is charging resident for services not provided and Staff are not administering medication(s) to resident according to physician's orders are UNFOUNDED.

Based on interviews and records review, the facility continues to provide R1 with services. R1 was not admitted to PACE Bakersfield and was not attending the program every day. Per interviews and records review, the facility is providing the R1’s medication and pain medications.
Unfounded
Estimated Days of Completion:
SUPERVISORS NAME: Sergiy Pidgirny
LICENSING EVALUATOR NAME: Lady Cabrera
LICENSING EVALUATOR SIGNATURE:

DATE: 10/20/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/20/2021
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 2
Control Number 24-AS-20210930171438
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: REDWOOD SENIOR LIVING BAKERSFIELD
FACILITY NUMBER: 157209136
VISIT DATE: 10/20/2021
NARRATIVE
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This agency has investigated the complaint alleging (Facility is charging resident for services not provided. Staff are not administering medication(s) to resident according to physician's orders). We have found that the complaint was unfounded, therefore we have dismissed the complaint.

Exit interview was conducted. Licensee was provided with a copy of this report.
SUPERVISORS NAME: Sergiy Pidgirny
LICENSING EVALUATOR NAME: Lady Cabrera
LICENSING EVALUATOR SIGNATURE:

DATE: 10/20/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/20/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 2