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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157201395
Report Date: 01/22/2024
Date Signed: 01/22/2024 03:06:13 PM

Document Has Been Signed on 01/22/2024 03:06 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:CNS ALTA PEAKFACILITY NUMBER:
157201395
ADMINISTRATOR:GRIGSBY, DIEDRAFACILITY TYPE:
735
ADDRESS:7510 ALTA PEAKTELEPHONE:
(661) 665-9980
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93313
CAPACITY: 5CENSUS: 0DATE:
01/22/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Administrator Nora RodriguezTIME COMPLETED:
10:15 AM
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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 Nora Rodriguez and was granted entry into the facility.

LPA conducted a tour inside and outside of facility. 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, LPA observed an adequate supply of food. Resident rooms checked. LPA observed an adequate supply of linen. Hot water measured at 120.8 degrees F. Exterior tour conducted, all exits open and free of obstructions. Side gate was observed to be self-latching and operating.

Fire extinguisher serviced on 10/03/2023. Smoke detectors and carbon monoxide detectors observed operational during today’s inspection. Medications were locked in a cabinet.

Administrator file was reviewed. Facility currently does not have any clients in care.

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

SUPERVISORS NAME: Sergiy Pidgirny
LICENSING EVALUATOR NAME: Shawna Doucette
LICENSING EVALUATOR SIGNATURE: DATE: 01/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/22/2024
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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