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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157202519
Report Date: 01/22/2024
Date Signed: 01/22/2024 03:05:21 PM

Document Has Been Signed on 01/22/2024 03:05 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 LOFTFACILITY NUMBER:
157202519
ADMINISTRATOR:CHRISTIE O'NEALFACILITY TYPE:
735
ADDRESS:1714 CRESTMONT DRTELEPHONE:
(661) 742-1383
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93306
CAPACITY: 4CENSUS: 4DATE:
01/22/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:15 AM
MET WITH:Administrator Assistant Samira Hernandez TIME COMPLETED:
01:45 PM
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Licensing Program Analyst (LPA) Shawna Doucette arrived at the facility unannounced to conduct the Required Annual Inspection. LPA met with Administrator Assistant Samira Hernandez and. LPA 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 72 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 08/23/23. Fire drill 01/11/24. Water temperature measured at 111.1 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.

A copy of this report was provided to the Administrator Assistant Samira Hernandez.

SUPERVISORS NAME: Sergiy Pidgirny
LICENSING EVALUATOR NAME: Shawna Doucette
LICENSING EVALUATOR SIGNATURE: DATE: 01/22/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/22/2024
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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