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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157209304
Report Date: 03/26/2024
Date Signed: 03/26/2024 01:01:57 PM


Document Has Been Signed on 03/26/2024 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
CCLD Regional Office, 1314 E SHAW AVE
FRESNO, CA 93710



FACILITY NAME:HALLMARK OF BAKERSFIELDFACILITY NUMBER:
157209304
ADMINISTRATOR:CANDELAS, ASHLEY L.FACILITY TYPE:
740
ADDRESS:2001 AKERS ROADTELEPHONE:
(661) 834-0200
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93309
CAPACITY:99CENSUS: 54DATE:
03/26/2024
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME BEGAN:
10:56 AM
MET WITH:Administrator, Ashley CandelasTIME COMPLETED:
12:56 PM
NARRATIVE
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Licensing Program Analyst (LPA) Darius Williams conducted a continuation Annual Visit, from 3/6/2024, regarding review of facility files.

LPA reviewed 5 resident files and 5 employee files. 5 of 5 resident files had documents requested by the LPA. LPA did request for Administrator to obtain clarification from a physician regarding a needs and services for Resident 3.

Employee files had all documents requested by the LPA and initial training. LPA observed initial training regarding general Diabetes procedures, however there was not specific Diabetes training regarding Resident 3.

Based on records review a deficiency is being cited on the attached LIC809D page.

An exit interview was conducted and a copy of this report and appeal rights was provided.
SUPERVISOR'S NAME: Serigy PidgirnyTELEPHONE: (559) 246-0610
LICENSING EVALUATOR NAME: Darius WilliamsTELEPHONE: 559-243-8080
LICENSING EVALUATOR SIGNATURE:
DATE: 03/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/26/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 3


Document Has Been Signed on 03/26/2024 01:01 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1314 E SHAW AVE
FRESNO, CA 93710


FACILITY NAME: HALLMARK OF BAKERSFIELD
FACILITY NUMBER: 157209304

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/26/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
87613(a)(A)
(A)Training shall include hands-on instruction in both general procedures and resident-specific procedures.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in that facility staff did not have specific training regarding Resident 3 needs, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 04/05/2024
Plan of Correction
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Administrator agreed to identify a licensed skilled professional to provide specific training regarding Resident 3's needs. Administrator to submit training records to Department by POC due date of 4/5/2024. LPA reviewed regulation with Administrator.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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: Serigy PidgirnyTELEPHONE: (559) 246-0610
LICENSING EVALUATOR NAME: Darius WilliamsTELEPHONE: 559-243-8080
LICENSING EVALUATOR SIGNATURE:
DATE: 03/26/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/26/2024
LIC809 (FAS) - (06/04)
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