157209136-7-21-2022-24-AS-SMOA-CGXUCG-20220803152755

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 157209136
Report Date: 07/21/2022
Date Signed: 07/21/2022 02:57:05 PM

Unsubstantiated

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
05/04/2022 and conducted by Evaluator Kamaldeep Kaur

COMPLAINT CONTROL NUMBER: 24-AS-20220504083259

FACILITY NAME:	REDWOOD SENIOR LIVING BAKERSFIELD		FACILITY NUMBER:	157209136
ADMINISTRATOR:	ESPINAL, KENNY		FACILITY TYPE:	740
ADDRESS:	810 S UNION AVE		TELEPHONE:	(415) 810-0145
CITY:	BAKERSFIELD	STATE: CA	ZIP CODE:	93307
CAPACITY:	41	CENSUS: 40	DATE:	07/21/2022
		UNANNOUNCED	TIME BEGAN:	01:45 PM
MET WITH:	Medtech/Staff Barbara Martin		TIME COMPLETED:	03:00 PM

ALLEGATION(S):

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Facility staff hit resident with broom stick.

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) K.Kaur conducted an unannounced complaint visit to deliver findings. LPA K. Kaur met with Staff/Medtech Barbara Martin and discussed the purpose of the visit.

In regard to the allegation Facility staff hit resident with broom stick, LPA K. Kaur interviewed residents, staff and, reviewed documents. LPA was unable to determine if the accusation occurred after investigation.

Although the allegations Facility staff hit resident with broom stick may have happened or is valid, there is not a preponderance of evidence to prove the alleged violations did or did not occur, therefore the allegation is UNSUBSTANTIATED.

Exit interview conducted. A copy of this report was discussed and provided to Medtech Barbara Martin, whose signature on this form confirms receipt of this document.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: See Moua	TELEPHONE: (559) 580-4596
LICENSING EVALUATOR NAME: Kamaldeep Kaur	TELEPHONE: (559) 341-7449
LICENSING EVALUATOR SIGNATURE:	DATE: 07/21/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/21/2022

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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