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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157202487
Report Date: 08/26/2021
Date Signed: 08/26/2021 04:35:23 PM

Document Has Been Signed on 08/26/2021 04:35 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:MISSION WELLS, INC. SADDLEBACKFACILITY NUMBER:
157202487
ADMINISTRATOR:RAMIREZ, CLAUDIAFACILITY TYPE:
735
ADDRESS:7008 SADDLEBACK DR.TELEPHONE:
(661) 832-3400
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93309
CAPACITY: 5CENSUS: 4DATE:
08/26/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:01 AM
MET WITH:Helen Houck, LicenseeTIME COMPLETED:
11:30 AM
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Licensing Program Analyst (LPA) A. Walton arrived unannounced at the above facility LPA introduced self, stated the purpose of the visit and requested to meet with the Administrator. LPA met with Licensee, Helen Houck who arrived a short time later. Upon entry to the facility, LPA observed staff not wearing facial coverings, staff donned a surgical face mask after LPA entered.

A tour of the facility was conducted. COVID-19 guidelines are in place. Visitor log-in/temperature check was observed upon entry. Facility has one entrance/exit point.

Facility appeared cleaned with no obstruction or fire clearance issues. Hand sanitizer was readily available to residents and visitors. Social distancing is maintained in the common and dining areas. Bathrooms have trash cans with lid. Hand washing posters were observed by the bathroom sink. Bedrooms are single occupant.

LPA checked residents’ locked medications and observed a 30-day supply. Food supply was checked and there appeared to be an adequate supply. Cleaning and PPE supplies were checked. Staff records were reviewed for good health and infection control training. Residents wear masks when away from the community. 3 out of 4 Resident files do not have updated emergency contact information.

No deficiencies were observed. Exit interview was conducted. Licensee was informed that as a COVID-19 precautionary measure, this report will be provided via email and an electronic read receipt confirms receiving this document. Facility Representative signature on file.
SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Alexandria Walton
LICENSING EVALUATOR SIGNATURE: DATE: 08/26/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/26/2021
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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