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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157203376
Report Date: 06/29/2021
Date Signed: 06/29/2021 05:15:20 PM

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:ABLE CARE HOMES 1FACILITY NUMBER:
157203376
ADMINISTRATOR:ZAPATA, BARBARAFACILITY TYPE:
740
ADDRESS:10005 COBBLESTONE AVENUETELEPHONE:
(661) 858-0385
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93311
CAPACITY:6CENSUS: 6DATE:
06/29/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Caregiver, Virginia TurelloTIME COMPLETED:
11:36 AM
NARRATIVE
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On 06/29/2021, Licensing Program Analyst (LPA) A. Walton conducted an Annual Inspection at the above facility. LPA introduced self and stated the purpose of the visit. Caregiver, Virginia Turello contacted Administrator, Barbara Zapata. Administrator is unable to attend this inspection due to a previously scheduled appointment. LPA received verbal permission to conduct the inspection with Caregiver.

Facility tour conducted. Upon entering the kitchen, LPA observed Clorox wipes on the counter in the kitchen, near the stove, accessible to residents. Caregiver removed the Clorox wipes and placed the items in a locked cabinet. LPA observed a 7 day supply of non-perishable foods and a 2- day supply of perishable foods. LPA observed a 30 day supply of medications for residents. Facility has a 30 day supply of PPE and cleaning supplies.

LPA did not observe signs promoting social distancing, cough/sneeze, and hand washing. Bedrooms were checked. Bed were observed to be at least 6 feet apart. . Staff records were reviewed for good health and infection control training. Facility staff was observed with mask on. Residents wear masks when away from the community. Resident’s files have updated emergency contact information. Administrator certification is current.

Based on today's inspection a deficiency is being cited in accordance with California Code of Regulations, Title 22, see LIC809D. An exit interview was conducted. A Plan of Correction was reviewed and developed with Administrator. A copy of this report and appeal rights were reviewed and provided via email due to COVID-19 precautionary measures. An electronic read receipt confirms receiving this document. Facility Representative signature on file.
SUPERVISOR'S NAME: Melinda HoffmannTELEPHONE: (559) 650-7914
LICENSING EVALUATOR NAME: Alexandria WaltonTELEPHONE: (559) 246-0128
LICENSING EVALUATOR SIGNATURE:

DATE: 06/29/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/29/2021
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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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: ABLE CARE HOMES 1
FACILITY NUMBER: 157203376
DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/29/2021

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
87309(a)
(a) Disinfectants, cleaning solutions, poisons, firearms and other items which could pose a danger if readily available to clients shall be stored where inaccessible to clients.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above when Clorox wipes were found on the kitchen counter accessible to residents in care, which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 06/29/2021
Plan of Correction
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Caregiver removed the Clorox wipes and placed the wipes in a secure cabinet inaccessible to residents. Administrator stated staff will receive a follow up training on Storage Space. POC CLEARED during inspection.
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: Melinda HoffmannTELEPHONE: (559) 650-7914
LICENSING EVALUATOR NAME: Alexandria WaltonTELEPHONE: (559) 246-0128
LICENSING EVALUATOR SIGNATURE:
DATE: 06/29/2021
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/29/2021
LIC809 (FAS) - (06/04)
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