<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157202532
Report Date: 03/22/2022
Date Signed: 03/22/2022 03:47:23 PM

Document Has Been Signed on 03/22/2022 03:47 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:KERN TRANSITION HOME-RIVER GLENFACILITY NUMBER:
157202532
ADMINISTRATOR:GONZALEZ, TIFFANYFACILITY TYPE:
735
ADDRESS:4409 RIVER GLEN DRIVETELEPHONE:
(661) 213-3800
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93308
CAPACITY: 4CENSUS: 4DATE:
03/22/2022
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
12:31 PM
MET WITH:Caregiver, Jose GarzaTIME COMPLETED:
01:17 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 03/22/2022, Licensing Program Analyst (LPA) A. Walton arrived unannounced to conduct a POC visit. LPA introduced self, stated the purpose of the visit and requested to meet with the Administrator. Facility staff attempted to contact Administrator, Brandy Frazier and Administrator, Donte Williams via telephone and did not receive a response. LPA met with Facility Staff, Jose Garza. Administrator, Brandy Frazier returned LPA's call a short time later and gave LPA verbal permission to meet with Caregiver, Jose Garza.

The purpose of today's visit is to follow up on the Plan of Correction for a deficiency issued on 01/31/2022. Facility did not submit Proof of Correction to the Fresno CCL office by the POC due date. LPA will re-issue the citation that was issued on 01/31/2022.

A deficiency is being cited on the attached 809D in accordance with the California Code of Regulations, Title 22.

An exit interview was conducted with Facility staff and Administrator via telephone. A Plan of Correction was reviewed and developed with Administrator. A copy of this report and appeal rights was discussed and will be provided via email due to COVID-19 precautionary measures. Report signed on-site.
SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Alexandria Walton
LICENSING EVALUATOR SIGNATURE: DATE: 03/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/22/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
Document Has Been Signed on 03/22/2022 03:47 PM - It Cannot Be Edited


Created By: Alexandria Walton On 03/22/2022 at 12:52 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: KERN TRANSITION HOME-RIVER GLEN
FACILITY NUMBER: 157202532

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 03/22/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
04/15/2022
Section Cited
CCR
80087(a)

1
2
3
4
5
6
7
80087 Buildings and Grounds: (a) The facility shall be clean, safe, sanitary and in good repair at all times for the safety and well-being of clients, employees and visitors. This requirement is not met as evidenced by:
1
2
3
4
5
6
7
Licensee agrees to repair or replace the toilent tank, window screens, broken chair and window blinds and submit proof to the Fresno CCL office by the POC due date.
8
9
10
11
12
13
14
Based on observation, the licensee did not comply with the section cited above as evidenced by the broken toilet tank, missing window screens, broken chair, and missing window blinds which poses a potential health, safety or personal rights risk to persons in care.
8
9
10
11
12
13
14

1
2
3
4
5
6
7
1
2
3
4
5
6
7

1
2
3
4
5
6
7
1
2
3
4
5
6
7
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:Melinda Hoffmann
LICENSING EVALUATOR NAME:Alexandria Walton
LICENSING EVALUATOR SIGNATURE:
DATE: 03/22/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/22/2022


LIC809 (FAS) - (06/04)
Page: 2 of 2