<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157202387
Report Date: 06/24/2024
Date Signed: 06/24/2024 01:11:40 PM

Document Has Been Signed on 06/24/2024 01:11 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
FRESNO RO, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME:MOUNTAIN VIEW RANCH RES. CAREFACILITY NUMBER:
157202387
ADMINISTRATOR/
DIRECTOR:		NANKIL, PATRICK R.FACILITY TYPE:
735
ADDRESS:3046 HINSLEY STTELEPHONE:
(661) 319-3749
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93307
CAPACITY: 4CENSUS: 4DATE:
06/24/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:26 AM
MET WITH:Patrick Nankil, AdministratorTIME VISIT/
INSPECTION COMPLETED:
01:20 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
LPA arrived at this facility unannounced to conduct annual inspection. LPA introduced herself and purpose of the visit and was granted entry by staff Moo Paw. LPA called Administrator Patrick Nankil (AD) to inform him of this LPA's presence at this facility. Facility was toured with Staff Sylvia Alita. During this visit all residents were in the facility.

LPA observed that the kitchen was well maintained, with working lights and well maintained appliances. The knives were kept in a locked drawer. The kitchen counters and sink are free from debris, under the sink are extra sponges. LPA observed a trash bin with the lid. LPA observed that refrigerator well maintained and clean. The kitchen cabinets are clean, organized, and had 7 days of non-perishable food. No expired food was observed.

Staff opened the medication cabinet for inspection. LPA observed medication cabinet has designated section for each resident, labeled and organized.

First aid kit was inspected and found to contain the required items.

LPA observed the dining room is well lit and clean. Dining table has seating for 3 with space for client with wheelchair. Carbon monoxide detector tested and found to be functioning

LPA observed the living room has electric fireplace. Television was observed to be in a secure place. LPA observed sofas. The living room can accommodate at least 6 people. The living room has a door that leads to the backyard. The furniture was clean and in good condition.

The smoke detector was tested by staff and found to be functioning. They are interconnected. A fire extinguisher stored in entry closet and was purchased on 10/23/23 with the correct pressure gauge as indicated on the meter.
SUPERVISORS NAME: Sergiy Pidgirny
LICENSING EVALUATOR NAME: Lissett Padgett
LICENSING EVALUATOR SIGNATURE: DATE: 06/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/24/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 6
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
FRESNO RO, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME: MOUNTAIN VIEW RANCH RES. CARE
FACILITY NUMBER: 157202387
VISIT DATE: 06/24/2024
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
LPA inspected the staff bathroom and observed that the bathroom is well maintained, well lit, toilet paper, hand soap, a trash bin with lid.

LPA observed the linen closet to have clean towels, linens, blankets are organized.

Laundry room is kept locked; has washer and dryer, cleaning supplies are stored in the cabinets.

LPA observed that the garage is well maintained, free from obstructions and debris. The garage has locked storage cabinets for extra toiletries, cleaning supplies and air fresheners. Extra Refrigerator and freezer contained extra meat and food.

This facility has 5 bedrooms. 3 are occupied by the residents and 2 are allocated for Staff.

LPA inspected #1 resident bedrooms with DSP. LPA observed Bedroom #1 has a private bathroom with covered trash bin, cabinets for toiletries, grab bars, and a shower bench. The toilet was flushed and is functioning. The water temperature measured at 111.4 degrees F. The bedroom has good lighting. Require furniture is present and in good condition, the linens are in good condition. Window and screen in good condition.

Client in Bedroom 2 was sleeping with door locked. LPA did not enter. LPA observed that bedroom #3 and #4 are single bedrooms with private bathroom. The bedrooms have adequate lighting. Window and screen are in good condition. Bedrooms have required furniture. Closet stores the residents' clothing and personal belongings. Furniture and linens are free from stains and are well maintained. Bathroom temperature was observed to be 114.3 and 115.7. In bedroom 3, LPA observed no curtains on the window. Staff explained that Client had pulled them off. Client stated he had been without curtains for two days.

LPA with AD inspected the backyard. LPA, observed that the backyard is well maintained. Patio chairs are ready for use. The exterior walkways are free from obstructions and debris.

LPA inspected bedroom allocated as Staff Room with staff. This room stores extra furniture, pillows and refrigerator (empty). LPA did not observe any hazards.
SUPERVISORS NAME: Sergiy Pidgirny
LICENSING EVALUATOR NAME: Lissett Padgett
LICENSING EVALUATOR SIGNATURE:

DATE: 06/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/24/2024
LIC809 (FAS) - (06/04)
Page: 2 of 6
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
FRESNO RO, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME: MOUNTAIN VIEW RANCH RES. CARE
FACILITY NUMBER: 157202387
VISIT DATE: 06/24/2024
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
LPA reviewed residents and staff records with AD and found that all documents are in order and up to date.
LPA is requesting the following documents be submitted to the Fresno CCL office by 7/1/2024: Designation of Facility Responsibility (LIC308), Administrator Organization (LIC 309), Affidavit regarding Client/Resident Cash Resources (LIC 400), Liability Insurance, Emergency and Disaster Plan (LIC 610D) Personnel Report (LIC500), Register of Facility Clients/Residents for (LIC9020A), Surety Bond.
SUPERVISORS NAME: Sergiy Pidgirny
LICENSING EVALUATOR NAME: Lissett Padgett
LICENSING EVALUATOR SIGNATURE:

DATE: 06/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/24/2024
LIC809 (FAS) - (06/04)
Page: 3 of 6
Document Has Been Signed on 06/24/2024 01:11 PM - It Cannot Be Edited


Created By: Lissett Padgett On 06/24/2024 at 12:52 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: MOUNTAIN VIEW RANCH RES. CARE
FACILITY NUMBER: 157202387

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/24/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
80087(a)
Building and Grounds
(a) The facility shall be clean, safe, sanitary and in good repair at all times for the safety and well-being of clients, employees and visitors.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observed in one clients bedroom there were no curtains. Client stated he had been without curtains for two days. The licensee did not comply with the section cited above which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/01/2024
Plan of Correction
1
2
3
4
Licensee ordered new curtains during this visit and will send this LPA verification that they have been installed. In the meantime Licensee will provide a temporary window covering until the new curtains arrive.
Section Cited
Deficient Practice Statement
1
2
3
4
POC Due Date:
Plan of Correction
1
2
3
4
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:Lissett Padgett
LICENSING EVALUATOR SIGNATURE:
DATE: 06/24/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/24/2024


LIC809 (FAS) - (06/04)
Page: 4 of 6