157202532-5-2-2023-24-AS-LSAR-CRFSXV-20230502141633

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 157202532
Report Date: 05/01/2023
Date Signed: 05/02/2023 02:16:51 PM

Document Has Been Signed on 05/02/2023 02:16 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 GLEN		FACILITY NUMBER:	157202532
ADMINISTRATOR:	WILLIAMS, DONTE		FACILITY TYPE:	735
ADDRESS:	4409 RIVER GLEN DRIVE		TELEPHONE:	(661) 213-3800
CITY:	BAKERSFIELD	STATE: CA	ZIP CODE:	93308
CAPACITY: 4		CENSUS: 4	DATE:	05/01/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	03:15 PM
MET WITH:	Brandy Frazier, Program Director		TIME COMPLETED:	09:13 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 05/01/23, Licensing Program Analyst (LPA) L. Salazar arrived to the facility unannounced to conduct the required Annual Inspection Visit. LPA was greeted by Program Director (PD), stated the purpose of the visit and was allowed entry into the facility. Administrator provided a tour of the facility inside and out. LPA observed 4 residents in care at the time of visit. Facility is a 4 bedroom 2 bathroom home. Residents bedrooms were observed to have the required lighting and furnishings and were free from odor and free from any passageway obstruction. Facility temperature was 71 degrees F. Bathrooms were toured and observed to have operational lights, running water, and non- slip floors. Hot water temperature tested at 112 degrees F. Medications were observed to be locked in a medication cart located in the living room. Cleaning supplies were observed to be locked under the kitchen sink. LPA toured the kitchen observed the required 7-day supply of non-perishable food and 2- day supply of fresh perishables to be properly stored. There are no residents with Restricted Health conditions in the facility. Carbon monoxide and smoke detectors were tested and observed to be operational Fire Extinguisher was observed with a service date of 07/2022 . First aid kit was observed and contained all required items. A working phone line were observed to be available for residents in care. (Continued from 809)

SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Lisa Salazar
LICENSING EVALUATOR SIGNATURE:	DATE: 05/01/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/01/2023

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

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 GLEN	FACILITY NUMBER: 157202532
	VISIT DATE: 05/01/2023

NARRATIVE

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(Continued from 809)

The exterior tour of back yard was conducted and found to be free from debris. A covered outdoor seating area was not observed for residents in care. Side gate was self-closing and self-latching. Quarterly Emergency Disaster Drill logs were observed for staff.

The following documents are requested and submitted to Fresno CCL by: 05/15/23:
LIC 308, LIC 400, LIC 402, LIC 500, LIC 610D, LIC 9020 Emergency and Disaster Plan.

An exit interview was conducted with Program Administrator . A copy of this report was discussed and provided at the time of visit. Due to time restraints, resident and staff files will be reviewed and observed at a later date. No deficiencies cited on today's visit.

SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Lisa Salazar
LICENSING EVALUATOR SIGNATURE:	DATE: 05/01/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/01/2023

LIC809 (FAS) - (06/04)

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