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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157202392
Report Date: 06/07/2023
Date Signed: 06/12/2023 09:47:44 AM

Document Has Been Signed on 06/12/2023 09:47 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:PLANZFACILITY NUMBER:
157202392
ADMINISTRATOR:CRANDELL, ROBERTFACILITY TYPE:
735
ADDRESS:4500 PLANZ RDTELEPHONE:
(661) 835-8969
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93309
CAPACITY: 4CENSUS: 4DATE:
06/07/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:55 PM
MET WITH:Licensee, Dinafay CrandellTIME COMPLETED:
02:11 PM
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Licensing Program Analyst (LPA) Darius Williams conducted an unannounced annual visit. LPA Williams met with Licensee, Dinafay Crandell and discussed the purpose of the visit. All clients were currently out of the facility participating in programs.

LPA Williams toured the facility with the Licensee.

The living room was clean and in good repair and had seating for all clients. The facility thermostat reflected a temperature of approximately 74 degrees Fahrenheit. The dining room was next to the living room and had seating for all clients.

The kitchen was clean and in good repair. The refrigerator had food and the temperature reflected approximately 40 degrees F. There was additional food in the freezer and a large freezer in storage with more food. Water temperature reflected approximately 110.5 degrees F.

Four bedrooms were toured. All rooms had dresser, nights stands, lamp, chair, and bed with required linens. Two bathrooms are available for the clients use. Both bathrooms were clean and in good repair.

LPA Williams observed extra supplies, linens, hygiene, non-perishable food in storage. Chemicals and medications were observed locked and inaccessible to clients.

Smoke detector, carbon monoxide, and fire extinguisher were present and operational.

*Continued on LIC 809-C*
SUPERVISORS NAME: Serigy Pidgirny
LICENSING EVALUATOR NAME: Darius Williams
LICENSING EVALUATOR SIGNATURE: DATE: 06/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/07/2023
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: PLANZ
FACILITY NUMBER: 157202392
VISIT DATE: 06/07/2023
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LPA Williams reviewed 4 client files and 2 employee files, which all had required documentation.

No deficiencies observed during the visit.

An exit interview was conducted and a copy of this report will be provided via e-mail.
SUPERVISORS NAME: Serigy Pidgirny
LICENSING EVALUATOR NAME: Darius Williams
LICENSING EVALUATOR SIGNATURE:

DATE: 06/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/07/2023
LIC809 (FAS) - (06/04)
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