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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157203395
Report Date: 06/14/2022
Date Signed: 06/14/2022 03:26:45 PM


Document Has Been Signed on 06/14/2022 03:26 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:BROOKDALE RIVERWALKFACILITY NUMBER:
157203395
ADMINISTRATOR:WEBSTER, REGFACILITY TYPE:
741
ADDRESS:350 CALLOWAY DRTELEPHONE:
(661) 587-0221
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93312
CAPACITY:376CENSUS: 220DATE:
06/14/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:35 PM
MET WITH:Reg WebsterTIME COMPLETED:
04:01 PM
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On 6/14/22, Licensing Program Analyst (LPA), M. Medina arrived at the facility unannounced to conduct the required Infection Control Inspection. LPA was greeted by concierge, COVID screening was completed prior to LPA's entry. LPA observed a central entry point with a supply of hand sanitizer at entrance. A sign in policy that includes documented routine symptom screening for visitors is currently being implemented to follow current visitation guidelines.

Facility tour of both Buildings A & B conducted with Administrator. Required postings of signs to include hand washing, coughing etiquette and physical distancing were observed throughout the facility. Staff were all observed wearing face coverings. Facility has designated visitation areas. LPAs observed a 30 day supply of PPE and resident medications. Fire extinguisher present throughout both buildings with a date of service of 1/26/22. Buildings are equipped with pull station and fire sprinklers.

Administrator to submit the following documents to Fresno CCL off no later than 7/01/22: Administrator Certificate, LIC 500, LIC 610, and LIC 9020.

Through LPA's observation of documentation and interview with Administrator, the required infection control practices are found to be in compliance. No deficiencies were observed. Exit interview was conducted and report signed. A copy of this report left for facility records.
SUPERVISOR'S NAME: Melinda HoffmannTELEPHONE: (559) 341-3247
LICENSING EVALUATOR NAME: Melinda MedinaTELEPHONE: (559) 410-5914
LICENSING EVALUATOR SIGNATURE:
DATE: 06/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/14/2022
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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