<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157203451
Report Date: 01/27/2025
Date Signed: 01/27/2025 02:57:44 PM

Document Has Been Signed on 01/27/2025 02:57 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:
01/27/2025
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:58 AM
MET WITH:Romeo ValeroTIME VISIT/
INSPECTION COMPLETED:
03:15 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 1/27/2025, Licensing Program Analysts (LPAs) M. Medina and L. Salazar conducted an unannounced Annual Continuation visit to facility. LPAs arrived, introduced self, stated purpose of visit, and allowed entrance by Caregiver. Licensee/Administrator, Amabelle Bernales contacted by telephone and arrived a short time later to conduct facility visit.

Resident bedrooms toured, bedroom for Resident 1 (R1) observed to need a lamp and new window blinds. Resident bathroom toured, water temperature measured at 119 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 does not meet the requirement of a 7-day supply of non-perishable food available or a 2-day supply of perishable food. LPA observed refrigerator to have leftovers that are not properly dated, and perishable food observed to have mold. LPA observed food in freezer to not be properly stored and labeled.

Outside of facility toured. LPA observed a ladder, and a shovel in back yard that need to be secured. LPA observed no seating available for residents. Both sheds in the backyard are locked, secured, and inaccessible to residents. LPA observed miscellaneous items on the side of storage shed that need to be removed.

All deficiencies observed are being cited on the attached 809-D.

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: 01/27/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/27/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 3
Document Has Been Signed on 01/27/2025 02:57 PM - It Cannot Be Edited


Created By: Melinda Medina On 01/27/2025 at 02:22 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1314 E SHAW AVE
FRESNO, CA 93710

FACILITY NAME: MEADOW RISE FACILITY
FACILITY NUMBER: 157203451

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/27/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
85087.2(b)
Outdoor Activity Space
(b) The outdoor activity area shall provide a shaded area, and shall be comfortable, and furnished for outdoor use.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on LPA's observation there is no outside seating area for residents, the licensee did not comply with the section cited above in which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 02/07/2025
Plan of Correction
1
2
3
4
Licensee to provide outside patio table and chairs for residents by plan of correction due date
Type B
Section Cited
HSC
1537.1(a)
Regulations
(a) A licensee of a residential facility serving adults that has internet service shall provide at least one internet access device, such as a computer, smart phone, tablet, or other device, that can support real-time interactive applications, is equipped with videoconferencing technology, including microphone and camera functions, and is dedicated for client use.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on interview, the licensee did not comply with the section cited above which poses/posed a potential health, safety or personal rights risk to persons in care. Facility is not equipped with a electronic device for residents.
POC Due Date: 02/14/2025
Plan of Correction
1
2
3
4
Licensee will purchase an electronic device for facility by plan of correction due date.
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 Hoffmann
LICENSING EVALUATOR NAME:Melinda Medina
LICENSING EVALUATOR SIGNATURE:
DATE: 01/27/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/27/2025


LIC809 (FAS) - (06/04)
Page: 2 of 3
Document Has Been Signed on 01/27/2025 02:57 PM - It Cannot Be Edited


Created By: Melinda Medina On 01/27/2025 at 02:22 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1314 E SHAW AVE
FRESNO, CA 93710

FACILITY NAME: MEADOW RISE FACILITY
FACILITY NUMBER: 157203451

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/27/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
80076(a)(18)
Food Service
(a) In facilities providing meals to clients, the following shall apply: (18) All food shall be protected against contamination. Contaminated food shall be discarded immediately.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation, LPA observed leftover food in the refrigerator without dates. Items in the freezer observed to not be properly stored and labeled. The licensee did not comply with the section cited above in which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 02/14/2025
Plan of Correction
1
2
3
4
Licensee will ensure that all food in the refrigerator and freezer are properly stored, labeled, and protected from contamination at all times.
Type B
Section Cited
CCR
85076(d)(1)
Food Service
(1) Supplies of staple nonperishable foods for a minimum of one week and fresh perishable foods for a minimum of two days shall be maintained on the premises.

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on observation, the licensee did not comply with the section cited above, facility does not have a 2-day supply of perishable and a 7-day supply of non-perishable food available which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 02/14/2025
Plan of Correction
1
2
3
4
Licensee will ensure adequate food supply per regulation is available at all times.
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 Hoffmann
LICENSING EVALUATOR NAME:Melinda Medina
LICENSING EVALUATOR SIGNATURE:
DATE: 01/27/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/27/2025


LIC809 (FAS) - (06/04)
Page: 3 of 3