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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157202389
Report Date: 10/19/2023
Date Signed: 10/30/2023 08:22:24 AM

Document Has Been Signed on 10/30/2023 08:22 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:KREBS RANCH HOMEFACILITY NUMBER:
157202389
ADMINISTRATOR:MCCRAW, CHERYLFACILITY TYPE:
735
ADDRESS:6304 KREBS RDTELEPHONE:
(661) 587-5290
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93308
CAPACITY: 2CENSUS: 2DATE:
10/19/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:46 PM
MET WITH:Cheryl McCraw, Administrator TIME COMPLETED:
02:05 PM
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On 10/18/23, Licensing Program Analyst (LPA) L. Salazar arrived to the facility unannounced to conduct the required Annual Inspection Visit. LPA was greeted by Direct Support Personnel (DSP), stated the purpose of the visit and was allowed entry into the facility. Administrator was contacted and was available at the time of visit. DSP provided a tour of the facility inside and out.

LPA observed 1 resident in care at the time of visit. Facility is a 3 bedroom 2 bathroom home. Resident bedrooms were observed to have the required lighting and furnishings and were free from odor and free from any passageway obstruction. Facility temperature was 76 degrees F. Bathrooms were toured and observed to have operational lights, running water, and non- slip floors. Hot water temperature tested at 118 degrees F.

Medications were observed to be locked medication cabinet located in the laundry room. Cleaning supplies were observed to be locked closet next to the entry way. LPA toured the kitchen observed the required 7-day supply of non-perishable food and 2- day supply of fresh perishables to be properly stored. There are no residents with Restricted Health conditions in the facility.

Carbon monoxide and smoke detectors were tested and observed to be operational Fire Extinguisher was observed with a service date of 05/12/2023 . First aid kit was observed and contained all required items. A working phone line was observed to be available for residents in care. A sample of resident and staff files were reviewed and observed to have the required documents.

The exterior tour of back yard was conducted and found to be free from debris. A covered outdoor seating area was observed for residents in care. Side gate was self-closing and self-latching. (Continued from 809-C)
SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Lisa Salazar
LICENSING EVALUATOR SIGNATURE: DATE: 10/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/19/2023
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME: KREBS RANCH HOME
FACILITY NUMBER: 157202389
VISIT DATE: 10/19/2023
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(Continued from 809)

The following documents are requested and submitted to Fresno CCL by: 11/05/23:
LIC 308, LIC 400, LIC 402, LIC 500, LIC 610D, LIC 9020.

An exit interview was conducted with Administrator. A copy of this report was discussed and provided at the time of visit. No deficiencies cited on today's visit.

SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Lisa Salazar
LICENSING EVALUATOR SIGNATURE:

DATE: 10/19/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/19/2023
LIC809 (FAS) - (06/04)
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