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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157202423
Report Date: 02/05/2024
Date Signed: 02/05/2024 03:48:53 PM


Document Has Been Signed on 02/05/2024 03:48 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:SPRING HOMEFACILITY NUMBER:
157202423
ADMINISTRATOR:NEBRIDA, OFELIA CUDALFACILITY TYPE:
740
ADDRESS:8722 HOODSPORT AVETELEPHONE:
(661) 587-6177
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93312
CAPACITY:5CENSUS: 5DATE:
02/05/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:31 PM
MET WITH:Ofelia NebridaTIME COMPLETED:
04:10 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
On 2/05/2024, Licensing Program Analyst (LPA) M. Medina conducted an unannounced Annual Required Inspection. LPA introduced self, stated purpose of visit, and allowed entrance by Direct Care Staff.

Currently, there are five (5) residents in place. All residents were present during inspection. Residents were observed participating in various activities during facility visit.

Facility tour conducted with Administrator. Facility observed to be clean, odor free, and comfortable temperature. Facility tour began in resident rooms, all bedrooms are private. All rooms observed to have all required accommodations. Resident bathrooms observed to have grab bars near toilet. LPA observed showers to also have grab bars, non-skid mats, and shower chair available. Water temperature measured at 115 degrees F. All common areas have adequate seating available for residents. Kitchen toured, LPA observed facility to have adequate food supply for residents in care. Knives observed to be locked, secured, and inaccessible to residents. Cleaning supplies observed to be locked and secured under kitchen sink. Medications observed to be locked and secured in kitchen cabinet. Medications observed to have original labels, and administered as prescribed.

Smoke detectors and carbon monoxide detectors present and observed operational during inspection. Facility is equipped with pull station and sprinklers. Fire Extinguisher present with a service date of 7/31/2023. Last fire drill conducted on 12/10/23 according to facility records.

Outside area toured. All exits open free of obstruction. No hazards observed.

LPA reviewed staff and resident files. LPA received the following during inspection: Administrator certificate, LIC 308, LIC 500, LIC 9020, and certificate of liability insurance.

No deficiencies observed
SUPERVISOR'S NAME: Melinda HoffmannTELEPHONE: (559) 341-3247
LICENSING EVALUATOR NAME: Melinda MedinaTELEPHONE: (559) 410-5914
LICENSING EVALUATOR SIGNATURE:
DATE: 02/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/05/2024
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 1