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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157202473
Report Date: 05/18/2024
Date Signed: 05/18/2024 04:47:38 PM

Document Has Been Signed on 05/18/2024 04:47 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:HARTNETTFACILITY NUMBER:
157202473
ADMINISTRATOR/
DIRECTOR:
CRANDELL, ROBERTFACILITY TYPE:
735
ADDRESS:5009 HARTNETT COURTTELEPHONE:
(661) 396-0465
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93306
CAPACITY: 4CENSUS: 3DATE:
05/18/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:42 PM
MET WITH:Staff Marvin KillianTIME VISIT/
INSPECTION COMPLETED:
03:30 PM
NARRATIVE
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Licensing Program Analyst (LPA) Shawna Doucette arrived at the facility unannounced to conduct the Required Annual Inspection. LPA was granted entry into the facility by Staff Alma Arrula. LPA contacted Licensee Dina Fay Crandell via telephone who gave permission for Staff Marvin Killian to assist with the visit. Staff Marvin Killiam responded to the facility and met with LPA.

A tour of the facility was conducted with the Staff. The residence was set at 78 F temperature and free of passageway obstructions inside and outside.

LPA Doucette observed 5 bedrooms in the residence. Residents' rooms were toured and inspected. Rooms were found to be clean. Hot water temperature was measured 105 F.

Kitchen toured, supply of food observed and food stored properly for perishable and nonperishable. Knives were stored in a locked closet. Medications were stored in a locked cabinet in the kitchen. Cleaning supplies were in a locked in laundry room. Smoke detectors and carbon monoxide detectors were checked and operating. Facility has a pull station fire alarm. Fire extinguishers were charged and had service dates of 1/2/24. Fire drill was last completed on 5/1/24.

LPA observed a self latching gate on the outside of the residence. There was outdoor seating for the residents.

Resident and medication records were reviewed. LPA was unable to review staff records or staff training due to the records not being accessible.

An exit interview was conducted with the Staff. A copy of this report was discussed with the Staff, Marvin Killiam, whose signature on this form confirm receipt of these documents.

SUPERVISORS NAME: Sergiy Pidgirny
LICENSING EVALUATOR NAME: Shawna Doucette
LICENSING EVALUATOR SIGNATURE: DATE: 05/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/18/2024
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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Document Has Been Signed on 05/18/2024 04:47 PM - It Cannot Be Edited


Created By: Shawna Doucette On 05/18/2024 at 02:45 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: HARTNETT

FACILITY NUMBER: 157202473

DEFICIENCY INFORMATION FOR THIS PAGE:

VISIT DATE: 05/18/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
80066(e)
Personnel Records
(e) All personnel records shall be maintained at the facility site.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on interview and observation, the licensee did not comply with the section cited above in Licensee did not have staff files available for LPA to review, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 05/24/2024
Plan of Correction
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Licensee agrees to come up with a plan for files to be in the facility and available for Licensing personnel to review and Licensee agrees to submit Administrator and staff on duty during visits file and training by POC due date
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Shawna Doucette
LICENSING EVALUATOR SIGNATURE:
DATE: 05/18/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/18/2024


LIC809 (FAS) - (06/04)
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