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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157203451
Report Date: 01/14/2025
Date Signed: 01/14/2025 01:45:05 PM

Document Has Been Signed on 01/14/2025 01:45 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:MEADOW RISE FACILITYFACILITY NUMBER:
157203451
ADMINISTRATOR/
DIRECTOR:		BERNALES, AMABELLEFACILITY TYPE:
735
ADDRESS:624 MEADOW RISE COURTTELEPHONE:
(661) 399-2655
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93308
CAPACITY: 5CENSUS: 3DATE:
01/14/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:56 AM
MET WITH:Romeo ValeroTIME VISIT/
INSPECTION COMPLETED:
02:05 PM
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On 1/14/2025, Licensing Program Analyst (LPA) M. Medina conducted an unannounced Annual Inspection to facility. LPA arrived, introduced self, stated purpose of visit, and allowed entrance by Caregiver. Licensee/Administrator, Amabelle Bernales contacted by telephone and was not available to conduct facility inspection. Administrator authorized LPA to conduct facility tour and inspection with staff present.

LPA conducted facility tour with Caregiver, Romeo Valero. Facility is a 5 bedroom, 2 bathroom home. Currently, there are 3 residents in care. One resident was present during today's inspection, resident 1 (R1) attends day program Monday, Thursday, and Friday. Resident 2 (R2) attends day program daily, and Resident 3 (R3) attends work daily.

Facility observed to be well lit, and odor free. Resident bedrooms toured, all bedrooms observed to have required furnishings available. Resident bathroom toured, water temperature measured at 120 degrees F. Shower/Tub observed to have a non-skid mat and shower chair available. Toilet observed to continuously run after flushing. Both toilet and sink observed to need cleaning. All common areas of facility have adequate seating available for residents. Kitchen toured, LPA observed facility to have a 7-day supply of non-perishable food available, but did not have a 2-day supply of perishable food. LPA observed refrigerator in need of cleaning. LPA observed both sharps and knives to be locked and secured in kitchen cabinet. All cleaning supplies were locked under sink as well as in laundry room.

Medication observed to be locked and secured in kitchen cabinet. Medication observed to have original labels and to be administered as prescribed.

Fire extinguisher present with a service date of 5/15/2024. Carbon monoxide and smoke detectors observed operational during inspection. Last fire drill conduced 7/18/2024 according to facility records. First Aid kit and manual present in medication cabinet.
SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Melinda Medina
LICENSING EVALUATOR SIGNATURE: DATE: 01/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/14/2025
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: MEADOW RISE FACILITY
FACILITY NUMBER: 157203451
VISIT DATE: 01/14/2025
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Outside of facility toured. LPA observed a ladder on back patio that needs to be secured. A couch on back patio observed to need repair or replacement. There is a RV parked in the back yard on the grass that needs to be removed. Both sheds in the backyard are locked, secured, and inaccessible to residents. LPA observed boards and miscellaneous items on the side of storage shed that need to be removed.

Due to resident files not being available today. LPA will return at a later date to complete inspection tool and review resident files.

All deficiencies observed today and documented will be cited during annual continuation inspection at a later date.

Exit interview conducted. A copy of report provided to staff for facility records.
SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Melinda Medina
LICENSING EVALUATOR SIGNATURE:

DATE: 01/14/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/14/2025
LIC809 (FAS) - (06/04)
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