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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157202598
Report Date: 11/08/2023
Date Signed: 11/08/2023 01:01:11 PM

Document Has Been Signed on 11/08/2023 01:01 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:
11/08/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Administrator Cheryl McCrawTIME COMPLETED:
01:15 PM
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Licensing Program Analyst LPA Shawna Doucette arrived at the facility unannounced and conducted an Annual Inspection on this date. Upon LPA's arrival there was no answer at the door. LPA contacted Administrator Cheryl McCraw via telephone, who responded to the facility to assist with the visit.

LPA conducted a tour inside and outside of facility. Facility observed to be clean, and at a comfortable temperature. Common areas were furnished well with adequate seating and lighting available. Kitchen toured, appeared clean and safe for food preparation. Food supply checked, LPA observed an adequate supply of food.

Resident rooms checked. LPA observed an adequate supply of linen. Hot water measured at 110.1 degrees F. Facility was set at 70 F.

Exterior tour conducted, all exits open and free of obstructions. Side gate was observed to be self-latching.

Fire extinguisher serviced on 04/10/2023. Smoke detectors and carbon monoxide detectors observed operational during today’s inspection. Last fire drill conducted 7/15/2023. All cleaning supplies are locked in the laundry room.

An exit interview was conducted with the Administrator and a copy of this report was provided.

SUPERVISORS NAME: Sergiy Pidgirny
LICENSING EVALUATOR NAME: Shawna Doucette
LICENSING EVALUATOR SIGNATURE: DATE: 11/08/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/08/2023
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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