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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157202855
Report Date: 08/08/2024
Date Signed: 08/08/2024 12:27:56 PM

Document Has Been Signed on 08/08/2024 12:27 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:MISSION SPRINGS, INC.- HESKETHFACILITY NUMBER:
157202855
ADMINISTRATOR/
DIRECTOR:		RAMIREZ, CLAUDIAFACILITY TYPE:
735
ADDRESS:5901 HESKETH DRIVETELEPHONE:
(661) 321-9119
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93309
CAPACITY: 4CENSUS: 4DATE:
08/08/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:56 AM
MET WITH:Claudia Yvonne Ramirez
Crystianna Robinson		TIME VISIT/
INSPECTION COMPLETED:
12:45 PM
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On 8/08/2024, Licensing Program Analyst (LPA) M. Medina conducted an Annual/Required visit. LPA met with Administrator, Claudia "Yvonne" Ramirez and Crystianna Robinson, Administrative Assistant to conduct facility tour and record review.

Currently, there are four (4) residents in care. Facility tour conducted. Facility is a 5 bedroom home with 4 private bedrooms and one bedroom is utilized as staff office. Facility observed to be clean and odor free. Adequate seating and lighting observed in both the living room, and dining room. Resident bedrooms have all required accommodations. Resident bathroom toured, all fixtures observed operational. LPA measured water temperature at 111 degrees F during inspection. Kitchen toured, LPA observed a 2-day supply of perishable food and a 7-day supply of non-perishable food. All medications observed to be locked and secured in kitchen cabinet, medication observed to have original labels and appear to be administered as ordered. All cleaning supplies are locked and secured in bathroom, and under kitchen sink. Smoke detectors and carbon monoxide observed to be operational during today's inspection. Fire extinguisher present with a service date of 5/14/24. Last fire drill was conducted on 6/13/2024.

Outside of facility toured. All exits open free of obstruction, no hazards observed.

LPA requested the following documents to be submitted to Fresno Regional Office no later than 8/22/24: copy of administrator certificate, LIC 308, LIC 500, LIC 610, and LIC 9020.

No deficiencies cited during today's visit. Exit interview conducted and a copy of report provided for facility records.
SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Melinda Medina
LICENSING EVALUATOR SIGNATURE: DATE: 08/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/08/2024
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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