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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157202907
Report Date: 10/01/2021
Date Signed: 10/01/2021 03:49:42 PM

Document Has Been Signed on 10/01/2021 03:49 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:HALF MOON HOMEFACILITY NUMBER:
157202907
ADMINISTRATOR:SANCHEZ, NESTORFACILITY TYPE:
735
ADDRESS:3509 SOUTH HALF MOON DRIVETELEPHONE:
(661) 833-6333
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93309
CAPACITY: 6CENSUS: 5DATE:
10/01/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:50 AM
MET WITH:Cheryl McCraw, AdministratorTIME COMPLETED:
10:30 AM
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On 10/1/21 at 8:50 AM, Licensing Program Analyst (LPA) Malia Thao arrived unannounced to conduct an Annual inspection. LPA explained reason for inspection and was granted entry by staff. Administrator (ADM) Cheryl McCraw arrived a short time later.

LPA toured inside and outside of facility. Facility was observed clean and without any obstructions or fire clearance issues. Hand sanitizer was readily available to residents and visitors. Social distancing is maintained in the common and dining areas. Hand washing posters were observed by sinks. Residents each have a private room. LPA checked residents’ medications and observed the month's supply. Food supply was observed in adequate supply. Cleaning and PPE supplies were checked. Residents files have updated emergency contact information. Administrator certification is current.

The following forms are to be submitted to CCL within 2 weeks:

LIC610D, LIC500, LIC400, LIC402, current lease agreement, LIC308

No deficiencies observed or cited.


Exit interview was conducted. A copy of this report will be sent to email on record with "Read receipt" to confirm receipt of this report.
SUPERVISORS NAME: Andy Xiong
LICENSING EVALUATOR NAME: Malia Thao
LICENSING EVALUATOR SIGNATURE: DATE: 10/01/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/01/2021
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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