157202519-8-3-2023-24-AS-SDOE-CUCRUC-20230803131944

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 157202519
Report Date: 08/03/2023
Date Signed: 08/03/2023 01:20:19 PM

Document Has Been Signed on 08/03/2023 01:20 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:	CRESTMONT LOFT		FACILITY NUMBER:	157202519
ADMINISTRATOR:	CHRISTIE O'NEAL		FACILITY TYPE:	735
ADDRESS:	1714 CRESTMONT DR		TELEPHONE:	(661) 742-1383
CITY:	BAKERSFIELD	STATE: CA	ZIP CODE:	93306
CAPACITY: 4		CENSUS: 4	DATE:	08/03/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:43 AM
MET WITH:	Administrator Assistant Samira Hernandez and Administrator Christie O'Neal		TIME COMPLETED:	01:30 PM

NARRATIVE

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Licensing Program Analyst (LPA) Shawna Doucette arrived at the facility unannounced to conduct the Required Annual Inspection. LPA's met with Administrator Assistant Samira Hernandez and Administrator Christie O'Neal. LPA's disclosed the purpose of the inspection and was granted entry into the facility by Staff Edith Falcon.

A tour of the facility was conducted with the Assistant Administrator. The residence was set at 74 F temperature and free of passageway obstructions inside and outside.

Kitchen toured, supply of food observed and food stored properly for perishable and nonperishable. Medications were stored in a locked Medication cabinet. Cleaning supplies were in a locked closet. Smoke detectors and carbon monoxide detectors were checked and operating. Fire extinguishers were charged and had service dates of 09/29/22. Fire drill 06/27/23. Water temperature measured at 129.7 F.

There was outdoor seating for the residents. No pools or bodies of water.

Resident, medication and staff records were reviewed. Current first aid and CPR were reviewed.

Deficiency was issued. Refer to 809D.

A copy of this report with plan of correction and appeal rights were provided to the Administrator Assistant Samira Hernandez.

SUPERVISORS NAME: Sergiy Pidgirny
LICENSING EVALUATOR NAME: Shawna Doucette
LICENSING EVALUATOR SIGNATURE:	DATE: 08/03/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/03/2023

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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Document Has Been Signed on 08/03/2023 01:20 PM - It Cannot Be Edited

Created By: Shawna Doucette On 08/03/2023 at 01:03 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: CRESTMONT LOFT	FACILITY NUMBER: 157202519
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 08/03/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type A

Section Cited

CCR

80088(e)(1)

Fixtures, Furniture, Equipment, and Supplies

(e) Faucets used by clients for personal care such as shaving and grooming shall deliver hot water. (1) Hot water temperature controls shall be maintained to automatically regulate temperature of hot water delivered to plumbing fixtures used by clients to attain a hot water temperature of not less than 105 degrees F (40.5 degrees C) and not more than 120 degrees F (48.8 degrees C). This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, the licensee did not comply with the section cited above by the water temperature being 129.7 F which poses an immediate health, safety or personal rights risk to persons in care.
	POC Due Date: 08/03/2023
	Plan of Correction
1 2 3 4	Plan of Correction POC Licensee agrees to set water temperature between 105 F and 120 F by POC due date. Licensee was able to turn the water heater down and measure at 110.5 F clearing POC during visit.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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: 08/03/2023

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/03/2023

LIC809 (FAS) - (06/04)

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