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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157209136
Report Date: 09/06/2023
Date Signed: 09/06/2023 01:01:44 PM


Document Has Been Signed on 09/06/2023 01:01 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SIERRA CASCADE AC/SC, 1314 E SHAW AVE
FRESNO, CA 93710



FACILITY NAME:REDWOOD SENIOR LIVING BAKERSFIELDFACILITY NUMBER:
157209136
ADMINISTRATOR:PONCE, BEATRIZFACILITY TYPE:
740
ADDRESS:810 S UNION AVETELEPHONE:
(415) 810-0145
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93307
CAPACITY:41CENSUS: 41DATE:
09/06/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
11:45 AM
MET WITH:Licensee Representative Anthony BarbatoTIME COMPLETED:
01:30 PM
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On 9/6/2023, Licensing Program Analyst (LPA) K.Kaur conducted an unannounced Case Management visit. LPA met with Licensee Representative Anthony Barbato and announced the purpose of the visit.

LPA arrived at the facility to conduct case management visit for incident report CCLD received on 8/7/2023 for an incident that happened on 7/31/2023; where Resident (R1) was found at the back of the facility with an open wound on head. LPA conducted a record review on resident’s file and conducted interviews. Resident had a series of incidents in a two-week period. LPA requested additional information in regards to Emergency release follow up orders.

No deficiencies cited during this Case Management visit. LPA will review documentation and additional information when received to determine if follow up is necessary.

An exit interview was conducted with Licensee Representative Anthony Barbato. Report signed on-site and a copy of report will be emailed due to technical issues.
SUPERVISOR'S NAME: See MouaTELEPHONE: (559) -58-4596
LICENSING EVALUATOR NAME: Kamaldeep KaurTELEPHONE: 559-243-8080
LICENSING EVALUATOR SIGNATURE:
DATE: 09/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/06/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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