157209136-11-4-2021-24-AS-SPIY-C8PQDD-20211112110433

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 157209136
Report Date: 11/04/2021
Date Signed: 11/04/2021 03:35:23 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
07/28/2021 and conducted by Evaluator Darius Williams

PUBLIC

COMPLAINT CONTROL NUMBER: 24-AS-20210728164232

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: 38	DATE:	11/04/2021
		UNANNOUNCED	TIME BEGAN:	01:33 PM
MET WITH:	Licensee, Anthony Barbato		TIME COMPLETED:	02:56 PM

ALLEGATION(S):

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Facility is filthy

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Darius Williamd conducted a follow up complaint visit to deliver findings. LPA Williams met with Licensee, Anthony Barbato and discussed the purpose of the visit.

LPA Williams has condcuted observations of the facility and interviews.

On 11/4/2021, LPA Williams observed cluster of brown spots, which looked to be grease, totaling an approximate area of 4 feet wide by two feet high, on the kitchen backsplash wall behind the sink and on the window sill. Additionally, the drywall behind the sink is damaged, which looks to be from water.

Based on the LPA's observation, the preponderence of evidence standard has been met. Therefore the above allegations is found to be SUBSTANTIATED. California Code of Regulation Title 22, Division 6, Chapter 8, Article 5, Section 87303(a), is being cited on the attached LIC 9099D.

Plan of correction was reviewed with Licensee. Exit interview conducted and a copy of this report and appeal rights were provided.

Substantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Serigy Pidgirny	TELEPHONE: (559) 246-0610
LICENSING EVALUATOR NAME: Darius Williams	TELEPHONE: 559-243-8080
LICENSING EVALUATOR SIGNATURE:	DATE: 11/04/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/04/2021

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 4

Control Number 24-AS-20210728164232

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: 11/04/2021

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 11/11/2021 Section Cited CCR 87303(a)	1 2 3 4 5 6 7	87303 Maintenance and Operation, (a) The facility shall be clean, safe, sanitary and in good repair at all times... This requirement was not met evident by:	1 2 3 4 5 6 7	Licensee has agreed to clean and paint the backsplash. Additionally, the Licensee has agreed to repair the drywall damage by Plan of Correction due date of 11/11/2021. Licensee has agreed to submit photo of corrections the Department by POC due date.
	8 9 10 11 12 13 14	Based on observation, the Licensee did not ensure the kitchen backsplash was clean and sanitary, which poses a potential health and safety risks to persons in care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

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: Serigy Pidgirny	TELEPHONE: (559) 246-0610
LICENSING EVALUATOR NAME: Darius Williams	TELEPHONE: 559-243-8080
LICENSING EVALUATOR SIGNATURE:	DATE: 11/04/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/04/2021

LIC9099 (FAS) - (06/04)

Page: 2 of 4

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
07/28/2021 and conducted by Evaluator Darius Williams

PUBLIC

COMPLAINT CONTROL NUMBER: 24-AS-20210728164232

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: 38	DATE:	11/04/2021
		UNANNOUNCED	TIME BEGAN:	01:33 PM
MET WITH:	Licensee, Anthony Barbato		TIME COMPLETED:	02:56 PM

ALLEGATION(S):

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Resident fell several times sustaining minor injuries
Staff left resident in soiled diaper for extended period of time
Staff did not administer resident's medication
Resident's wheelchair is in disrepair
Residents bed is not comfortable
Patio furniture is in disrepair
Facility has exposed wires

INVESTIGATION FINDINGS:

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Licensing Program Analyst (LPA) Darius Williams conducted a follow up complaint visit to deliver findings. LPA Williams with Licensee Anthony Barbato and discussed the purpose of the visit.

LPA Williams has conducted interviews, record reviews, and observations. Resident 1 was not available to interview.

In regards to the allegation, resident fell several times sustaining minor injures, the Licensee reported R1 had fallen while in care, but there were no visible injuries and R1 reported no injuries or concerns of pain. Staff 1 (S1) reported providing care for R1 and did not observe R1 fall.

In regards to the allegation, staff left resident in soiled diaper for extended period of time, Witness 1 reported staff tended to R1 when requested. S1 and Staff 2 reported conducting 30 minute checks for residents needs. Additonally, LPA Williams spoke to Resident 2 and Resident 3 who both reported staff assist withS their needs.

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Serigy Pidgirny	TELEPHONE: (559) 246-0610
LICENSING EVALUATOR NAME: Darius Williams	TELEPHONE: 559-243-8080
LICENSING EVALUATOR SIGNATURE:	DATE: 11/04/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/04/2021

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

Page: 3 of 4

Control Number 24-AS-20210728164232

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: 11/04/2021

NARRATIVE

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In regards to the allegation, staff did not administer resident's medication, LPA Williams reviewed R1's Medication Administration Record Sheet for July and August 2021. All medications were initialed, which according to the Licensee means the medications were administered to R1.

In regards to the allegation, residents wheel chair is in disrepair, LPA Williams observed a wheel chair that the Licensee identified as R1's. The wheel chair rolled and the breaking system was functional.

In regards to the allegation, residents bed is not comfortable, LPA Williams observed a bed in room 16. LPA Williams observed the mattress to be clean, good repair, and had structure.

In regards to the allegation, patio furniture is in disrepair, LPA Williams observed chairs and tables in the front and backyards. All furniture supported the weight of an individual and were not missing any pieces.

In regards to the allegation, facility has exposed wires, LPA Williams toured the facility common areas and did not observe any exposed wires in the floor, walls, or ceilings, that would pose a health and safety risk.

Although the above allegations 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 allegations are UNSUBSTANTIATED.

An exit interview was conducted and a copy of this report was provided.

SUPERVISOR'S NAME: Serigy Pidgirny	TELEPHONE: (559) 246-0610
LICENSING EVALUATOR NAME: Darius Williams	TELEPHONE: 559-243-8080
LICENSING EVALUATOR SIGNATURE:	DATE: 11/04/2021

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/04/2021

LIC9099 (FAS) - (06/04)

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