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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 157209136
Report Date: 06/25/2024
Date Signed: 06/25/2024 01:06:55 PM

Substantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
FRESNO RO, 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
06/21/2024 and conducted by Evaluator Lissett Padgett
PUBLIC
COMPLAINT CONTROL NUMBER: 24-AS-20240621101815
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:
06/25/2024
UNANNOUNCEDTIME BEGAN:
09:33 AM
MET WITH:Anthony Barbato, LicenseeTIME COMPLETED:
01:15 PM
ALLEGATION(S):
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Staff mismanages resident's medications.
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPA) Lissett Padgett and Kamaldeep Kaur conducted the complaint investigation visit to the facility. During the course of this complaint investigation LPA Kaur interviewed staff on duty and reviewed facility records. It was determined based on the interviews and records review that the above allegation is SUBSTANTIATED. Facility did not accurately document medications stored for resident.

Based on LPAs review of the Centrally Stored Medication and Destruction Record and Medication Administration Record (MAR) and medication, the preponderance of evidence standard has been met, therefore the above allegation(s) is found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division 6 are being cited on the attached LIC 9099D.
Substantiated
Estimated Days of Completion: 0
SUPERVISOR'S NAME: Sergiy PidgirnyTELEPHONE: (559) 246-0610
LICENSING EVALUATOR NAME: Lissett PadgettTELEPHONE: (559) 243-8080
LICENSING EVALUATOR SIGNATURE:

DATE: 06/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/25/2024
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-20240621101815
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
FRESNO RO, 1314 E SHAW AVE
FRESNO, CA 93710

FACILITY NAME: REDWOOD SENIOR LIVING BAKERSFIELD
FACILITY NUMBER: 157209136
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/25/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Deficiency Dismissed
Type B
07/05/2024
Section Cited
CCR
87465(h)(6)(C)(D)
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The following requirements shall apply to medications which are centrally stored:The licensee shall be responsible for assuring that a record of centrally stored prescription medications for each resident...includes: (C) The drug name, strength and quantity (D)The date filled.
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Accountability checks will be implimented on a daily basis. Licensee will provide training to Med Techs on how to document and review medication records for accuracy. Licensee will send verification that training has been completed to this LPA by the due date.
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This requirement is not met as evidenced by:
Review of the Centrally Stored Medication and Destruction Record and Medication Administration Record (MAR) and the medication the facility did not accurately document medications stored for 1 of 2 residents.
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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) 246-0610
LICENSING EVALUATOR NAME: Lissett PadgettTELEPHONE: (559) 243-8080
LICENSING EVALUATOR SIGNATURE:

DATE: 06/25/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/25/2024
LIC9099 (FAS) - (06/04)
Page: 2 of 2