Bakersfield Healthcare Center
730 34th Street, Bakersfield, CA 93301
Citation Number: 120006727
Citation Date: 1/19/2010
Violation Date: 12/15/2007
Class: AA
Penalty: $ 100,000

On 12/15/07, a 99 year old resident fell after getting out of bed, was found on the floor bleeding from her head, and then transferred to the hospital in an unconscious state. She died from severe brain injuries three days later. The facility was cited because it failed to implement a fall risk plan and failed to adequately address her safety needs. Although the facility had assessed the resident as being at a high risk of falls, it did not closely monitoring her safety. The violations were a direct proximate cause of the resident's death.