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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157203994
Report Date: 07/25/2022
Date Signed: 07/25/2022 11:58:59 AM

Document Has Been Signed on 07/25/2022 11:58 AM - 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:SAILS IFACILITY NUMBER:
157203994
ADMINISTRATOR:DELGADILLO, JESSICAFACILITY TYPE:
735
ADDRESS:7305 RUSTON LNTELEPHONE:
(661) 473-2345
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93309
CAPACITY: 2CENSUS: 2DATE:
07/25/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:40 AM
MET WITH:Jessica Delgadillo, AdministratorTIME COMPLETED:
12:15 PM
NARRATIVE
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On 7/25/22 at 10:40 AM, Licensing Program Analyst (LPA) Malia Thao arrived unannounced to conduct an Annual inspection. LPA was greeted by staff and granted entry. LPA met with Administrator Jessica Delgadillo.

Facility was observed without any obstructions or fire clearance issues. Hand sanitizer was readily available to residents and visitors. Social distancing is maintained in the common and dining areas. Hand washing posters were observed by the bathroom sinks. Bedrooms were checked and no residents share a room. LPA checked residents’ medications and observed the month's supply. Food supply was observed in adequate supply. Cleaning and PPE supplies were checked. Staff records were reviewed for good health. Residents files have updated emergency contact information. Administrator certification is valid.

The following deficiency was cited:

1. LPA found that the hall bathroom bathtub bottom coating was peeling off in a central area of approximately 36" by 16" and the underside of the non-skid mat observed with mildew and soap scum.

Deficiency is being cited based on LPA observations conducted in accordance with the California Code of Regulations, Title 22, see LIC809D.



Exit interview was conducted. A copy of this report and appeal rights were given to Administrator Jessica Delgadillo, whose signature confirms receipt of this report. Plan of Correction made with Administrator.
SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Malia Thao
LICENSING EVALUATOR SIGNATURE: DATE: 07/25/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/25/2022
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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Document Has Been Signed on 07/25/2022 11:58 AM - It Cannot Be Edited


Created By: Malia Thao On 07/25/2022 at 11:32 AM
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: SAILS I
FACILITY NUMBER: 157203994

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/25/2022

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
80087(a)
Building and Grounds
(a) The facility shall be clean, safe, sanitary and in good repair at all times for the safety and well-being of clients, employees and visitors.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above. LPA found that the hall bathroom bathtub bottom coating was peeling off in a central area of approximately 36" by 16" and the underside of the non-skid mat was observed with mildew and soap scum, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 08/08/2022
Plan of Correction
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Administrator will proof of hall bathroom bathtub replaced and non-skid mat replaced to CCL by POC due date.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Malia Thao
LICENSING EVALUATOR SIGNATURE:
DATE: 07/25/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/25/2022


LIC809 (FAS) - (06/04)
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