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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157203376
Report Date: 08/30/2022
Date Signed: 08/30/2022 03:18:51 PM


Document Has Been Signed on 08/30/2022 03:18 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: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:
08/30/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:45 PM
MET WITH:Barbara Zapata, Licensee TIME COMPLETED:
04:00 PM
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On 08/30/2022, Licensing Program Analyst (LPA) L. Salazar arrived at the facility unannounced to conduct an annual infection control inspection. LPA was met by licensee, stated purpose of the visit and was allowed entry into the facility. LPA toured the facility inside and out.

Facility Mitigation plan and Infection Control Plan has been submitted to CCL. Infection control procedures described in the plan were observed and reviewed with LPA include: Daily symptoms screenings (for staff, persons in care and visitors), testing, visitation, quarantine/isolation procedures, emergency staffing plan, PPE storage, use and training, as well as daily infection control procedures. The Administrator is identified as the Infection Control lead for the facility.

LPA toured the facility inside and out. Postings to encourage face coverings and hand washing were observed. Furniture in common and dining areas are spaced to promote distancing. Staff were all observed wearing face coverings. Facility has multiple designated visitation areas available. LPA observed 30-day medication supply was observed in a locked cabinet and PPE accessible to staff. Common and resident bathroom sinks are well stocked with liquid soap and paper towels for hand washing. LPA observed a two day supply of perishable food and seven day supply of non-perishable food. Cleaning supplies were observed locked in the garage and laundry room.

The following documents are requested and need to be submitted to Fresno
CCL by 9/16/2022. Designation of Facility Responsibility (LIC308) Administrator Organization (LIC309) Personnel Report (LIC500) Emergency and Disaster Plan (LIC610ES), and Register of Facility Clients (LIC9020). (continued on 809-C)
SUPERVISOR'S NAME: Melinda HoffmannTELEPHONE: (559) 341-3274
LICENSING EVALUATOR NAME: Lisa SalazarTELEPHONE: (559) 691-0004
LICENSING EVALUATOR SIGNATURE:
DATE: 08/30/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/30/2022
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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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
VISIT DATE: 08/30/2022
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(Continued from 809)

Through LPA’s observations, documentation review and interview with Administrator, the required infection control practices are found to be in compliance. No deficiencies cited on today’s inspection.

An exit interview was conducted with Administrator and a copy of the report was provided at the time of visit.
SUPERVISOR'S NAME: Melinda HoffmannTELEPHONE: (559) 341-3274
LICENSING EVALUATOR NAME: Lisa SalazarTELEPHONE: (559) 691-0004
LICENSING EVALUATOR SIGNATURE:

DATE: 08/30/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/30/2022
LIC809 (FAS) - (06/04)
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