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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 157209136
Report Date: 09/10/2021
Date Signed: 09/10/2021 02:44:56 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
08/31/2021 and conducted by Evaluator Katie Brown
COMPLAINT CONTROL NUMBER: 24-AS-20210831165239
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: 41DATE:
09/10/2021
UNANNOUNCEDTIME BEGAN:
12:15 PM
MET WITH:Anthony BarbatoTIME COMPLETED:
03:15 PM
ALLEGATION(S):
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Unlawful Eviction
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Katie Brown arrived at the facility unnanounced to conduct the 10 day complaint visit. LPA explained the purpose of the visit and elements of the allogation with Licensee, Anthony Barbato.

The Department has investigated the complaint alleging: Unlawful Eviction. Based on interview with the Licensee and record review of the 30 Day Notice of Eviction issued to R1 on 8/31/2021 it was determined that the Notice was not complete and therefore, unlawful. The preponderance of evidence standard has been met, therefore the allegation has been found to be SUBSTANTIATED.

The following deficiencies were observed and noted on the attached LIC 809D.

A copy of this report along with Appeal Rights were provided to Licensee Anthony Barbato. An exit interview was conducted with Licensee
Substantiated
Estimated Days of Completion: 60
SUPERVISOR'S NAME: Sergiy PidgirnyTELEPHONE: (559) 650-7923
LICENSING EVALUATOR NAME: Katie BrownTELEPHONE: (559) 243-8080
LICENSING EVALUATOR SIGNATURE:

DATE: 09/10/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/10/2021
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-20210831165239
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
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 09/10/2021
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
09/17/2021
Section Cited
CCR
87224(a)(1)
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87224 Eviction Procedures (a) The licensee may evict a resident for one or more of the reasons listed in Section 87224(a)(1) through (5). Thirty (30) days written notice to the resident is required except as otherwise specified in paragraph 5.

This requirement was not evidenced by:
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Licensee has agreed to revise the 30 Day Notice of Eviction to include the reason for eviction as specified along with cooresponding documentation. Licensee will submit a written statement to include the revisions to the notice to include 1. Reason for Eviction and 2. That a copy of the Notice will be provided to CCLD within 5 days if issue date.
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Licensee issued a 30 Day Notice of Eviction to R1 on 8/31/21 that did not include the reason for eviction, Nonpayment of the rate for basic services within ten days of the due date.

This poses a potential health and safety risk to persons in care.
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Licensee will submit the revised 30 Day Notice of Eviction and written statement to CCLD via email by 9/17/21.
CCR
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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: Sergiy PidgirnyTELEPHONE: (559) 650-7923
LICENSING EVALUATOR NAME: Katie BrownTELEPHONE: (559) 243-8080
LICENSING EVALUATOR SIGNATURE:

DATE: 09/10/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/10/2021
LIC9099 (FAS) - (06/04)
Page: 2 of 2