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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157202598
Report Date: 11/16/2022
Date Signed: 11/21/2022 03:27:54 PM

Document Has Been Signed on 11/21/2022 03:27 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:KAVALIER HOME KERN RESIDENTIAL SERVICES,INC.FACILITY NUMBER:
157202598
ADMINISTRATOR:GLENN, RHONDAFACILITY TYPE:
735
ADDRESS:1805 KAVALIER COURTTELEPHONE:
(661) 833-6625
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93304
CAPACITY: 6CENSUS: 6DATE:
11/16/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:59 PM
MET WITH:Administrator, Cheryl McCrawTIME COMPLETED:
03:08 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
Licensing Program Analyst (LPA) Darius Wiliams conducted an unannounced Annual Inspection visit. LPA Williams met with staff and discussed the purpose of the visit. Administrator Cheryl McCraw arrived shortly after conducted and conducted a tour with the LPA.

LPA Williams observed a visitor/temperature log, masks, and disinfection station at the front entrance. Facility has one entry and exit point. General infection control signs were observed in the common area.

LPA Williams observed a two day supply of perishable food and seven day supply of non-perishable food. Cleaning supplies and medications were observed behind a locked door. LPA Williams observed facility staff wearing masks.

Staff have received training regarding Covid-19 infection control and mitigation.6 of 6 residents had up to date emergency contact information.

LPA Williams requested the following documents be sent to the Department by 11/23/2022; personnel report (LIC 500) ,designation of facility responsibility (LIC 308), and Administrator certificate.

No deficiencies were cited.

An exit interview was conducted and a copy of this report was provided.
SUPERVISORS NAME: Serigy Pidgirny
LICENSING EVALUATOR NAME: Darius Williams
LICENSING EVALUATOR SIGNATURE: DATE: 11/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/16/2022
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 1