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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157203951
Report Date: 06/23/2022
Date Signed: 06/23/2022 01:11:46 PM


Document Has Been Signed on 06/23/2022 01:11 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:ST. CATHERINE'S HOME CARE, INC.FACILITY NUMBER:
157203951
ADMINISTRATOR:NECER, AMALIAFACILITY TYPE:
740
ADDRESS:10214 PINNACLE RIDGE AVE.TELEPHONE:
(661) 665-9405
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93311
CAPACITY:6CENSUS: 3DATE:
06/23/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:35 PM
MET WITH:Caregiver, Elias ValentinoTIME COMPLETED:
01:30 PM
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On 06/23/2022, Licensing Program Analyst (LPA) Walton arrived unannounced to conduct an annual inspection. LPA introduced self, stated the purpose of the visit and requested to meet with the Administrator. Facility staff contacted Administrator, Amalia Necer via telephone. Administrator is unable to attend today's inspection. LPA received verbal permission from the Administrator to meet with Caregiver, Elias Valentino.

Facility appeared cleaned with no obstruction or fire clearance issues. Hand sanitizer was available to residents and visitors. Social distancing is maintained in the common and dining areas. Bathrooms have a trash can with lid. Hand washing posters were observed by the bathroom sink. Resident bedrooms were checked. Beds were observed to be at six feet apart in the shared bedrooms.

LPAs checked residents’ locked medications. Food supply was checked and there appeared to be an adequate supply. Cleaning and PPE supplies were checked. Facility staff were observed wearing facial coverings.

LPA will return on a later date to conduct an Annual Continuation inspection to review resident and personnel records.

No deficiencies issued during today's inspection.

An exit interview was conducted. A copy of this report was discussed and provided to Caregiver, Elias Valentino, whose signature on this form confirms receiving this document.
SUPERVISOR'S NAME: Melinda HoffmannTELEPHONE: (559) 341-3274
LICENSING EVALUATOR NAME: Alexandria WaltonTELEPHONE: (559) 246-0128
LICENSING EVALUATOR SIGNATURE:
DATE: 06/23/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/23/2022
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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