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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157202449
Report Date: 03/25/2022
Date Signed: 04/01/2022 01:59:37 PM

Document Has Been Signed on 04/01/2022 01:59 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:PTS FOURFACILITY NUMBER:
157202449
ADMINISTRATOR:GONZALEZ, CARLOSFACILITY TYPE:
735
ADDRESS:9207 BLOSSOM TIME AVENUETELEPHONE:
(661) 496-8188
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93311
CAPACITY: 4CENSUS: 4DATE:
03/25/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
03:00 PM
MET WITH:Mariana Rodriguez, Adminsitrator TIME COMPLETED:
04:30 PM
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Licensing Program Analyst (LPA) L. Salazar and D. Ayers arrived at the facility unannounced to conduct a required annual inspection. LPA met with Administrator and announced the purpose of the visit. COVID precautionary measures were taken at the time of entry.

LPA toured the facility inside and outside. The facility was adequately furnished and lit throughout. All passageways and exits were clear and free from obstruction. The facility had multiple fire extinguishers with service tags. All smoke and carbon monoxide detectors were observed to be functional. Fire Extinguisher was observed to have a date of service 11/23/21. LPA observed a two day supply of perishable food stuffs and a seven day supply of nonperishable food stuffs which were stored properly in the facility. Medications were secured in a locked hall closet. LPA toured resident bedrooms and bathrooms. Resident bedrooms were adequately furnished, and bathrooms emergency/disaster plan was reviewed. LPA reviewed infection control guidelines and best practices with Administrator.

No deficiencies cited during the inspection. Exit interview conducted. A copy of the report was provided via email.

SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Lisa Salazar
LICENSING EVALUATOR SIGNATURE: DATE: 03/25/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/25/2022
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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