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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157200413
Report Date: 12/01/2023
Date Signed: 12/01/2023 04:56:50 PM

Document Has Been Signed on 12/01/2023 04:56 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:RIVERSIDE RANCH, ASC TREATMENT GROUPFACILITY NUMBER:
157200413
ADMINISTRATOR:MORENO, ELANAFACILITY TYPE:
735
ADDRESS:18200 HIGHWAY 178TELEPHONE:
(661) 871-9697
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93306
CAPACITY: 51CENSUS: 47DATE:
12/01/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:52 PM
MET WITH:Administrator Laura VargasTIME COMPLETED:
05:15 PM
NARRATIVE
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Licensing Program Analyst Shawna Doucette (LPA) arrived at the facility unannounced to conduct a Required Annual inspection. LPA was met by Administrator Laura Vargas.

LPA conducted a tour inside and outside of facility. Facility consisted of 3 separate houses on the property which were the Ranch House, The Garden House and the River House. Facility observed to be clean, and at a comfortable temperature. Common areas were furnished well with adequate seating and lighting available. Kitchen toured, appeared clean and safe for food preparation. Food supply checked. Resident rooms checked. LPA observed an adequate supply of linen. Hot water measured at 139.6, 119.6 and 106.6 degrees F. Exterior tour conducted, all exits open and free of obstruction. Facility as a pool which is fenced, locked and inaccessible to clients in care.

Fire extinguisher serviced on 08/2023. Smoke detectors and carbon monoxide detectors observed operational during today’s inspection. Last fire drill conducted 08/25/2023. All cleaning supplies are locked and secured in a cabinet under the kitchen sink.

Refer to 809D

An exit interview was conducted with the Administrator and a copy of this report with plan of correction and appeal rights was provided.

SUPERVISORS NAME: Sergiy Pidgirny
LICENSING EVALUATOR NAME: Shawna Doucette
LICENSING EVALUATOR SIGNATURE: DATE: 12/01/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/01/2023
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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Document Has Been Signed on 12/01/2023 04:56 PM - It Cannot Be Edited


Created By: Shawna Doucette On 12/01/2023 at 04:37 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

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

FACILITY NAME: RIVERSIDE RANCH, ASC TREATMENT GROUP
FACILITY NUMBER: 157200413

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 12/01/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
80088(e)(1)
80088 Furniture, Fixtures, Equipment, and Supplies

(e) Faucets used by clients for personal care such as shaving and grooming shall deliver hot water.

(1) Hot water temperature controls shall be maintained to automatically regulate temperature of hot water delivered to plumbing fixtures used by clients to attain a hot water temperature of not less than 105 degrees F (40.5 degrees C) and not more than 120 degrees F (48.8 degrees C).


This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above in 1 out of 3 faucets measured at 139.6 F which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 12/08/2023
Plan of Correction
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Licensee agrees to submit a photo to licensing of the water in the Ranch House measuring between 105 F to 120 F by POC due date 12/8/23.
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:Sergiy Pidgirny
LICENSING EVALUATOR NAME:Shawna Doucette
LICENSING EVALUATOR SIGNATURE:
DATE: 12/01/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/01/2023


LIC809 (FAS) - (06/04)
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