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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157202539
Report Date: 12/08/2022
Date Signed: 12/08/2022 11:21:21 AM

Document Has Been Signed on 12/08/2022 11:21 AM - 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:POSITIVE PURPOSE, LLCFACILITY NUMBER:
157202539
ADMINISTRATOR:BECKNER, JAMIEFACILITY TYPE:
735
ADDRESS:9008 STATEN ISLAND DRIVETELEPHONE:
(661) 847-9200
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93311
CAPACITY: 4CENSUS: 4DATE:
12/08/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:35 AM
MET WITH:Jamie Beckner, Administrator and Nikki Cockren, Administrator 2TIME COMPLETED:
11:25 AM
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On 12/8/22, Licensing Program Analyst (LPA) M. Yang arrived unannounced to conduct an Annual Inspection - Infection Control. LPA introduced self, stated the purpose of the visit, and requested to meet with administrator. LPA met with Amber Zargoza, staff. Jamie Beckner, Administrator and Nikki Cockren, Administrator 2 was called and arrived shortly and conduct tour with LPA. There was one client present during the inspection.

Upon entry facility staff was observed with facial covering. Visitor log-in/temperature check was observed upon entry. Hand sanitizer was readily available to residents and visitors. Facility has one entrance/exit point. Facility appeared cleaned with no obstruction or fire clearance issues. Social distancing is maintained in the common and dining areas. COVID-19 related sign and cough etiquette posting observed.

LPA checked residents’ locked medications. LPA observed 30 days PPE supplies. Food supply was checked and appeared to be an adequate supply. Cleaning supplies were stored and locked in hall closet. All resident’s room toured and observed to be adequately furnished and lit. LPA observed 4 single occupant room. All bathrooms observed trash bin with lid. Hand washing posting not observed by bathroom sinks. The exterior tour was conducted. Side gate was self-closing and free of debris. LPA observed fire extinguisher served date: 09/19/22. Staff records were reviewed for good health and infection control training. All four resident records reviewed to have updated emergency contact information.

No deficiencies issued during this inspection.

Exit Interview conducted. The following documents are requested and submitted to Fresno CCL by: 12/14/22. The following updated forms were requested: Lic 308, Lic 309, Lic 400, Lic 402, Lic 500, Lic 610D, Lic 9282, and control of property. LPA received copies of Administrator Lic 503 and current Administrator certificate. A copy of this report was provided to the Administrator via email.

SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Mai Yang
LICENSING EVALUATOR SIGNATURE: DATE: 12/08/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/08/2022
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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