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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 155801279
Report Date: 05/16/2023
Date Signed: 05/17/2023 10:17:03 AM


Document Has Been Signed on 05/17/2023 10:17 AM - 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:GABLES, THEFACILITY NUMBER:
155801279
ADMINISTRATOR:STEPHANIE HAROFACILITY TYPE:
740
ADDRESS:903 SPIRIT LAKE DRIVETELEPHONE:
(661) 213-3927
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93312
CAPACITY:6CENSUS: 3DATE:
05/16/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:34 AM
MET WITH:Christina MarsyTIME COMPLETED:
02:50 PM
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On 5/16/23, Licensing Program Analyst (LPA) M. Medina arrived unannounced to conduct the Annual Inspection. LPA met with and explained the purpose of the visit with Administrator, Christina Marsy.

During this visit, LPA toured the facility. Furniture and flooring in common rooms observed to be in good repair with adequate lighting throughout. Resident bedrooms have required furnishings, lighting and linens. The kitchen observed clean, in good repair with necessary items and appliances. LPA observed required food supply, paper products and PPE. Knives, cleaning/disinfecting supplies and chemicals are locked and stored separate from food. Medications are centrally stored and locked. Facility has designated visitation areas available inside and out. Outside of the facility toured. LPA observed a self-releasing gate and windows have screens in good repair. Doors and passageways are unobstructed throughout the home and outside. Fire Extinguishers dated 9/2022. Smoke and Carbon Monoxide detectors present and in working order. Emergency & Disaster Plan and Infection Control Procedures on site and available

LPA conducted resident and staff file reviews and interviews.

No deficiencies were cited during this inspection. An exit interview was conducted. A copy of this report was signed and left with Administrator for facility records.

LPA requested the following forms to be submitted to Fresno Regional Office no later than 5/26/23: Designation of Facility Responsibility (LIC 308), Personnel Report (LIC 500), Emergency Disaster Plan (610E), Client Roster (LIC 9020), Current Liability Coverage.

SUPERVISOR'S NAME: Melinda HoffmannTELEPHONE: (559) 341-3247
LICENSING EVALUATOR NAME: Melinda MedinaTELEPHONE: (559) 410-5914
LICENSING EVALUATOR SIGNATURE:
DATE: 05/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/16/2023
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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