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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157203139
Report Date: 08/26/2023
Date Signed: 08/26/2023 01:37:04 PM

Document Has Been Signed on 08/26/2023 01:37 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:KERN TRANSITION HOME-MEADOW OAKSFACILITY NUMBER:
157203139
ADMINISTRATOR:MANIGQUE, LESTERFACILITY TYPE:
735
ADDRESS:5813 MEADOW OAKS COURTTELEPHONE:
(661) 871-7410
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93306
CAPACITY: 4CENSUS: 4DATE:
08/26/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Administrator Lester ManigqueTIME COMPLETED:
12:00 PM
NARRATIVE
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Licensing Program Analyst (LPA) Shawna Doucette arrived at the facility unannounced to conduct the Required Annual Inspection. LPA disclosed the purpose of the inspection and was granted entry into the facility by Staff Melissa Carlile. Staff contacted Administrator Lester Manigque who responded to assist with the visit. LPA disclosed the purpose of the inspection and was granted entry into the facility by Staff.

A tour of the facility was conducted with the Staff Melissa Carlile. The residence was set at 72 F temperature and free of passageway obstructions inside and outside.

LPA Doucette observed 4 bedrooms in the residence. Residents' rooms were toured and inspected. Rooms were found to be clean. Hot water temperature was measured 105.8 F.

Kitchen toured, supply of food observed and food stored properly for perishable and nonperishable. Knives were stored in a locked cabinet. Medications were stored in a locked Medication cart. Cleaning supplies were in a locked cabinet in the garage. Smoke detectors and carbon monoxide detectors were checked and operating. Fire extinguishers were charged and had service dates of 1/20/23. Fire drill was last completed on 05/6/23. Facility has a pull station fire alarm. Facility has a sprinkler system.

LPA observed a self latching gate on the outside of the residence. There was outdoor seating for the residents.

Resident, medication and staff records were reviewed. Current first aid and CPR were on file for staff. Facility is licensed for all ambulatory clients. Facility has a non ambulatory client which has not been fire cleared.

An exit interview was conducted with the Administrator. A copy of this report, appeal rights and plan of correction were discussed and left with the Administrator. Civil penalties were issued.

SUPERVISORS NAME: Sergiy Pidgirny
LICENSING EVALUATOR NAME: Shawna Doucette
LICENSING EVALUATOR SIGNATURE: DATE: 08/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/26/2023
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 3
Document Has Been Signed on 08/26/2023 01:37 PM - It Cannot Be Edited


Created By: Shawna Doucette On 08/26/2023 at 11:23 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1314 E SHAW AVE
FRESNO, CA 93710

FACILITY NAME: KERN TRANSITION HOME-MEADOW OAKS
FACILITY NUMBER: 157203139

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/26/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
80020(a)
Fire Clearance
(a) All facilities shall secure and maintain a fire clearance approved by the city or county fire department, the district providing fire protection services, or the State Fire Marshal.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on interview and record review, the licensee did not comply with the section cited above by being licensed for ambulatory only and having non ambluatory client which poses an immediate health, safety or personal rights risk to persons in care. Civil Penalties issued.
POC Due Date: 08/28/2023
Plan of Correction
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Licensee agrees to submit a new application LIC 200 and facility sketch with a request to change license and fire clearance by POC due date 08/28/23.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Sergiy Pidgirny
LICENSING EVALUATOR NAME:Shawna Doucette
LICENSING EVALUATOR SIGNATURE:
DATE: 08/26/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/26/2023


LIC809 (FAS) - (06/04)
Page: 2 of 3
Document Has Been Signed on 08/26/2023 01:37 PM - It Cannot Be Edited


Created By: Shawna Doucette On 08/26/2023 at 11:23 AM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1314 E SHAW AVE
FRESNO, CA 93710

FACILITY NAME: KERN TRANSITION HOME-MEADOW OAKS
FACILITY NUMBER: 157203139

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 08/26/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
85064(k)
Administrator Qualifications and Duties
(k) Within six months of becoming an administrator, the individual shall receive training on HIV and TB required by Health and Safety Code Section 1562.5. Thereafter, the administrator shall receive updated training every two years.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on interview and record review, the licensee did not comply with the section cited above by Administrator not having the above training, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 09/22/2023
Plan of Correction
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Licensee agrees to have Administrator complete training to meet this regulation. Licensee agrees to submit proof of training by POC due date 09/22/23.
Section Cited
Deficient Practice Statement
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4
POC Due Date:
Plan of Correction
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4
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Sergiy Pidgirny
LICENSING EVALUATOR NAME:Shawna Doucette
LICENSING EVALUATOR SIGNATURE:
DATE: 08/26/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/26/2023


LIC809 (FAS) - (06/04)
Page: 3 of 3