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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 155801189
Report Date: 04/08/2021
Date Signed: 04/08/2021 11:06:01 AM

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:WESTCHESTER GARDENSFACILITY NUMBER:
155801189
ADMINISTRATOR:ROBINSON, SHERVETAFACILITY TYPE:
740
ADDRESS:2228 TRUXTUN AVETELEPHONE:
(661) 324-3091
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93301
CAPACITY:36CENSUS: 18DATE:
04/08/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Sherveta RobinsonTIME COMPLETED:
11:28 AM
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Licensing Program Analyst (LPA) M. Medina conducted a case management visit for the purpose of Health and Safety check of Residents in care.

LPA conducted facility tour with Administrator. LPA observed resident's in sitting in their bedrooms relaxing or watching television. Adequate food supply available to meet the needs of residents in care. Facility temperature observed to be a comfortable temperature. Fire extinguishers present and have a service date of 9/02/2020.

Per Administrator there are currently no residents on hospice and one resident receiving home health services.

No deficiencies cited during today's visit.
SUPERVISOR'S NAME: Melinda HoffmannTELEPHONE: (559) 650-7914
LICENSING EVALUATOR NAME: Melinda MedinaTELEPHONE: (559) 410-5914
LICENSING EVALUATOR SIGNATURE:

DATE: 04/08/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/08/2021
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC809 (FAS) - (06/04)
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