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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157203246
Report Date: 08/22/2022
Date Signed: 08/22/2022 10:21:20 AM

Document Has Been Signed on 08/22/2022 10:21 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:E & E RESIDENTIAL #2FACILITY NUMBER:
157203246
ADMINISTRATOR:NELSON, BRIANFACILITY TYPE:
735
ADDRESS:8917 ELLENSPORTTELEPHONE:
(661) 831-6209
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93313
CAPACITY: 5CENSUS: 5DATE:
08/22/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Assistant Administrator Sophia Nelson TIME COMPLETED:
10:30 AM
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On 08/22/22, Licensing Program Analyst (LPA) M. Yang arrived unannounced to conduct an Annual Inspection - Infection Control. LPA arrived at the facility and called Brian Nelson, Administrator. Administrator stated unable to attend meeting, Assistant Administrator will arrive at facility shortly. Assistant Administrator Sophia Nelson arrived shortly and conducted tour with LPA. There are currently no clients present during tour.

Upon entry facility staff was observed with facial mask. Visitor log-in/temperature check was observed upon entry. Hand sanitizer was readily available to clients and visitors. Facility has one entrance/exit point. Facility appeared cleaned with no obstruction or fire clearance issues. Social distancing is maintained in the common and dining areas. LPA observed social distancing and cough etiquette postings in facility. LPA observed fire extinguisher served date: 08/01/22.

All clients’ room toured and observed to be adequately furnished and lit. LPA observed one shared residents’ bed to be at least 6 feet apart and three single occupant room. Bathrooms observed trash bin with lid. LPA observed hand washing posting by all sinks. Cleaning supplies were stored and locked in cabinet in the garage. LPA observed a 30-day PPE supplies. Food supply was checked and appeared to be an adequate supply. The exterior tour was conducted. Side gate was self-closing and self-latching. Staff records were reviewed for good health and infection control training. All clients’ records reviewed to have updated emergency contact information. LPA checked clients’ locked medications.

No deficiencies issued during this inspection.

Exit Interview conducted. The following documents are requested and submitted to Fresno CCL by: 08/29/22. The following updated forms were requested: Lic 308, Lic 309, Lic 400, Lic 402, Lic 500, Lic 610D, Lic 9282 and current Administrator certificate. A copy of this report was provided to the Assistant Administrator.

SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Mai Yang
LICENSING EVALUATOR SIGNATURE: DATE: 08/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/22/2022
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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