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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 157209304
Report Date: 11/07/2024
Date Signed: 11/07/2024 01:59:11 PM

Substantiated


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
10/28/2024 and conducted by Evaluator Shawna Doucette
COMPLAINT CONTROL NUMBER: 24-AS-20241028085831
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: 64DATE:
11/07/2024
UNANNOUNCEDTIME BEGAN:
10:10 AM
MET WITH:Administrator Ashley CandelasTIME COMPLETED:
02:15 PM
ALLEGATION(S):
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Staff mishandles the residents medications
INVESTIGATION FINDINGS:
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Licensing Program Analysts (LPA) Shawna Doucette arrived at the facility unannounced to commence a complaint investigation. LPA identified herself and explained the purpose of the visit with Staff Stephanie Villanueva. LPA met with Administrator Ashley Candelas.

LPA interviewed staff and residents. LPA toured the facility. LPA obtained copies of order and took photos of medication error.
Based on records review R5 recieved a prescribed PRN on 11/3/24 at 8:07 PM and at 10:43 PM. PRN instructions state medication is to be given every 4 hours not more than twice within a 24 hour period.

Based on the Departments interviews and records review, the preponderance of evidence standard has been met, therefore the above allegation is found to be SUBSTANTIATED. California Code of Regulations, Title 22, Division 6, Article 8, is being cited on the attached LIC 9099D.
A copy of this report was provided.


An exit interview was conducted and a copy of this report was provided.
Substantiated
Estimated Days of Completion:
SUPERVISORS NAME: Sergiy Pidgirny
LICENSING EVALUATOR NAME: Shawna Doucette
LICENSING EVALUATOR SIGNATURE:

DATE: 11/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/07/2024
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 3
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
10/28/2024 and conducted by Evaluator Shawna Doucette
COMPLAINT CONTROL NUMBER: 24-AS-20241028085831

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: 64DATE:
11/07/2024
UNANNOUNCEDTIME BEGAN:
10:10 AM
MET WITH:Administrator Ashley CandelasTIME COMPLETED:
02:15 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff behavior poses as a risk to the residents
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analysts (LPA) Shawna Doucette arrived at the facility unannounced to commence a complaint investigation. LPA identified herself and explained the purpose of the visit with Staff Stephanie Villanueva. LPA met with Administrator Ashley Candelas.

LPA interviewed staff and residents. LPA toured the facility. LPA did not have any reports of staff behavior posing a risk to residents in care.

Based on interviews, it is undetermined whether or not the allegation occurred. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED.


An exit interview was conducted and a copy of this report was provided.
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Sergiy Pidgirny
LICENSING EVALUATOR NAME: Shawna Doucette
LICENSING EVALUATOR SIGNATURE:

DATE: 11/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/07/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 2 of 3
Control Number 24-AS-20241028085831
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: HALLMARK OF BAKERSFIELD
FACILITY NUMBER: 157209304
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/07/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
11/08/2024
Section Cited
CCR
87465(a)(4)
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87465 Incidental Medical and Dental Care (a) A plan for incidental medical and dental care shall be developed by each facility. The plan shall encourage routine medical and dental care and provide for assistance in obtaining such care, by compliance with the following:
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Plan of Correction POC Licensee agrees to do medication training 11/8/24 for all medication technicians
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(4) The licensee shall assist residents with self-administered medications as needed. This requirement was not met as evidenced by R5 was administered Acetaninophen on 11/3/24 at 8:07 PM and at 10:43 PM when the dr order states administer every 4 hours but not more than twice daily which poses an immediate health safety and or personal rights risk to residents in care.
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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.
SUPERVISORS NAME: Sergiy Pidgirny
LICENSING EVALUATOR NAME: Shawna Doucette
LICENSING EVALUATOR SIGNATURE:

DATE: 11/07/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/07/2024
LIC9099 (FAS) - (06/04)
Page: 3 of 3