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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157202855
Report Date: 07/12/2023
Date Signed: 07/17/2023 08:26:15 AM

Document Has Been Signed on 07/17/2023 08:26 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:MISSION SPRINGS, INC.- HESKETHFACILITY NUMBER:
157202855
ADMINISTRATOR:RAMIREZ, CLAUDIAFACILITY TYPE:
735
ADDRESS:5901 HESKETH DRIVETELEPHONE:
(661) 321-9119
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93309
CAPACITY: 4CENSUS: 4DATE:
07/12/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:38 PM
MET WITH:Administrator, Helen Houck
Administrative Assistant, Crystianna Robinson		TIME COMPLETED:
04:52 PM
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Licensing Program Analyst (LPA) Darius Williams conducted an unannounced Annual Inspection visit. LPA met with Administrator, Helen Houck and discussed the purpose of the visit.

LPA toured the facility with the Administrator.

The tour began in the kitchen. The kitchen was clean and in good repair. There were two weeks of non perishable food and two days of perishable food. The refrigerator temperature reflected approximately 41 degrees Fahrenheit (F).

The living room was clean, in good repair, and had seating for all clients.

LPA toured tow bathrooms. The bathrooms were clean and in good repair. Grab bars and non slip maps were available for clients needs. Water temperature in the hallway bathroom reflected approximately 105.1 degrees F.

Four bedrooms were toured. All bedrooms had working lights, dresser, bed , required linens, and dressers.

The backyard was free of obstruction and there is no pool on the premises.

The facility thermometer reflected 80 degrees F.

Chemicals and medications were observed behind locked cabinets.

*Continued on LIC 809-C*
SUPERVISORS NAME: Serigy Pidgirny
LICENSING EVALUATOR NAME: Darius Williams
LICENSING EVALUATOR SIGNATURE: DATE: 07/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/12/2023
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: MISSION SPRINGS, INC.- HESKETH
FACILITY NUMBER: 157202855
VISIT DATE: 07/12/2023
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Smoke alarm/carbon monoxide and fire extinguisher were present and operational.

First aid kit was present with all required items.

LPA reviewed four client files and two staff files, which had all required documents requested by the LPA.

No deficiencies were cited during this visit.

An exit interview was conducted and a copy of this report will be provided via e-mail.
SUPERVISORS NAME: Serigy Pidgirny
LICENSING EVALUATOR NAME: Darius Williams
LICENSING EVALUATOR SIGNATURE:

DATE: 07/12/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/12/2023
LIC809 (FAS) - (06/04)
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