Community Care Licensing

Document Has Been Signed on 10/22/2025 09:13 PM - It Cannot Be Edited

FACILITY NAME:	HOLDEN WAY HOME		FACILITY NUMBER:	157201351
ADMINISTRATOR/ DIRECTOR:	ROMERO, EDWARD		FACILITY TYPE:	735
ADDRESS:	2201 HOLDEN WAY		TELEPHONE:	(661) 832-3006
CITY:	BAKERSFIELD	STATE: CA	ZIP CODE:	93304
CAPACITY: 6		CENSUS: 6	DATE:	10/21/2025
TYPE OF VISIT:	Case Management - Deficiencies	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	04:43 PM
MET WITH:	Administrator, Edward Romero		TIME VISIT/ INSPECTION COMPLETED:	08:53 PM

NAME OF LICENSING PROGRAM MANAGER: Brenda Chan NAME OF LICENSING PROGRAM ANALYST: Lisa Salazar LICENSING PROGRAM ANALYST SIGNATURE: DATE: 10/21/2025

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/21/2025

Link to Parent Document Below:

FACILITY NAME: HOLDEN WAY HOME	FACILITY NUMBER: 157201351
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 10/21/2025

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type B 10/31/2025 Section Cited CCR 85069.3(a)	1 2 3 4 5 6 7	85069.3 Mental Health Intake Assessment (a) In order to determine his/her ability to provide the services needed by a client with mental illness, the licensee of an ARF shall ensure that a written intake assessment is prepared as required by Health and Safety Code Section 1562.6(a). (1) Health and Safety Code Section 1562.6(a) is paraphrased in pertinent part: The administrator of an adult residential care facility that provides services for residents who have mental illness shall ensure that a written intake assessment is prepared by a licensed mental health professional prior to acceptance of the client. This assessment may be provided by a student intern if the work is supervised by a properly licensed mental health professional. Facility administrators may utilize placement agencies, including, but not limited to, county clinics for referrals and assessments.	1 2 3 4 5 6 7	Licensee agrees to submit a plan to meet this regulation by POC due date 10/31/25
	8 9 10 11 12 13 14	This requirement was not met as evidenced by LPAs review of Resident R1's file. A psychosocial assessment was observed to be dated 09/27/18 and signed by an assessment coordinator at Frank Lanterman Regional Center, not a licensed mental health professional which poses a potential health safety and or personal rights risk to residents care.	8 9 10 11 12 13 14
Type B 10/31/2025 Section Cited CCR80069.2(c)(3)	1 2 3 4 5 6 7	80069.2 Functional Capabilites Assessment (c) Assessment of the client's need for assistance and care shall include consideration of the following: (3) Propensity for behaviors that result in harm to self or others and that require supervision.	1 2 3 4 5 6 7	Licensee agrees to submit a functional capabilities form for R1 by POC due date 10/31/25.
	8 9 10 11 12 13 14	This requirement was not evidenced by LPAs review of records, there is no functional capabilities assessment in Resident R1's file. If not corrected this poses a potential risk health safety and or personal rights risk to residents care.	8 9 10 11 12 13 14

Brenda Chan NAME OF LICENSING PROGRAM MANAGER: Lisa Salazar NAME OF LICENSING PROGRAM ANALYST: LICENSING PROGRAM ANALYST SIGNATURE: DATE: 10/21/2025

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/21/2025

Link to Parent Document Below:

FACILITY NAME: HOLDEN WAY HOME	FACILITY NUMBER: 157201351
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 10/21/2025

Deficiency Type POC Due Date / Section Number	DEFICIENCIES		PLAN OF CORRECTIONS(POCs)
Type A 10/22/2025 Section Cited CCR 85068.4(a)(3)	1 2 3 4 5 6 7	85068.4 Acceptance and Retention Limitations (a) The licensee shall not accept or retain the following: (3) Persons who have needs that are in conflict with the needs of other clients or the program of services offered.	1 2 3 4 5 6 7	Licensee agrees to submit a plan on how this regulation will be met by POC due date 10/22/25.
	8 9 10 11 12 13 14	This requirement is not met as evidenced by LPAs records review of resident files, and interviews conducted, R1 requires a higher level of care that includes psychiatric care, which are in conflict with the other residents in the home. If not corrected this violation poses an immediate risk health safety and or personal rights risk to residents care.	8 9 10 11 12 13 14
	1 2 3 4 5 6 7		1 2 3 4 5 6 7
	1 2 3 4 5 6 7		1 2 3 4 5 6 7

Brenda Chan NAME OF LICENSING PROGRAM MANAGER: Lisa Salazar NAME OF LICENSING PROGRAM ANALYST: LICENSING PROGRAM ANALYST SIGNATURE: DATE: 10/21/2025

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/21/2025