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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157203256
Report Date: 11/09/2023
Date Signed: 11/09/2023 02:01:20 PM

Document Has Been Signed on 11/09/2023 02:01 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:CARDIFFFACILITY NUMBER:
157203256
ADMINISTRATOR:SEDAM, RUSSFACILITY TYPE:
735
ADDRESS:5804 CARDIFF AVENUETELEPHONE:
(667) 837-8177
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93309
CAPACITY: 4CENSUS: 4DATE:
11/09/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:20 AM
MET WITH:Administrator, Gonzalo CruzTIME COMPLETED:
10:20 AM
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Licensing Program Analyst (LPA) Darius Williams conducted an unannounced Annual inspection visit. LPA met with Administrator Gonzalo, Cruz and discussed the purpose of the visit.

LPA Williams toured the facility with Administrator.

The kitchen was sanitary and in good repair. There were 2 days of perishable food and 7 days nonperishable food.

The dining and living room had seats to accommodate all clients. The facility thermostat reflected 67 degrees Fahrenheit (F).

LPA Williams observed 2 of 4 bedrooms. Each bedroom had a bed, with required linens, night stand, dresser, chairs, and working light. All bedrooms had space for clients to move around and the rooms were personalized.

Two bathrooms were sanitary and in good repair. There were non-slip mats and grab bars available for client use.

Smoke detectors and carbon monoxide detectors were present and operational. First aid kit was present and had all required items.

LPA observed medications and chemicals to be locked and inaccessible to clients.

*Continued on LIC 809C*

SUPERVISORS NAME: Serigy Pidgirny
LICENSING EVALUATOR NAME: Darius Williams
LICENSING EVALUATOR SIGNATURE: DATE: 11/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/09/2023
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: CARDIFF
FACILITY NUMBER: 157203256
VISIT DATE: 11/09/2023
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The backyard had a covered shaded area for client use. There is no pool on the premises.

LPA reviewed 4 client files and 2 employee files. All files had documentation that was requested.

No deficiency were observed during this visit.

LPA requested the following documents be provided to the Department: Liability Insurance, LIC 500 and LIC 308.

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: 11/09/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/09/2023
LIC809 (FAS) - (06/04)
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