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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157204005
Report Date: 11/07/2023
Date Signed: 11/08/2023 09:51:00 AM

Document Has Been Signed on 11/08/2023 09:51 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:SIERRA SPRINGS RESIDENTIAL CAREFACILITY NUMBER:
157204005
ADMINISTRATOR:NANKIL, PATRICKFACILITY TYPE:
735
ADDRESS:305 DANI ROSE LANETELEPHONE:
(661) 399-4787
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93308
CAPACITY: 4CENSUS: 4DATE:
11/07/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Partick Nankil, Licensee TIME COMPLETED:
03:15 PM
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On 11/07/23, Licensing Program Analyst (LPA) L. Salazar arrived to the facility unannounced to conduct the required Annual Inspection Visit. LPA was greeted by staff, stated the purpose of the visit and was allowed entry into the facility. Administrator arrived to the facility a few minutes later. Staff provided a tour of the facility inside and out. Administrator on record is Patrick Nankil.

LPA observed 2 residents in care at the time of visit. Facility is a 4 bedroom 3 bathroom home. Residents bedrooms were observed to have the required lighting and furnishings and were free from odor and free from any passageway obstruction / fire hazards. Facility temperature was 72 degrees F.

Bathrooms were toured and observed to have operational lights, running water, and non- slip floors. Hot water temperature tested at 109 degrees F. Trash can with lid and hand washing postings were observed.

Medications were observed to be locked in a cabinet located in the . Cleaning supplies were observed to be locked under the kitchen sink. LPA toured the kitchen observed the required 7-day supply of non-perishable food and 2- day supply of fresh perishables to be properly stored. There are no residents with Restricted Health conditions in the facility.

Carbon monoxide and smoke detectors were tested and observed to be operational. Night lights were observed in the hallways. Fire Extinguisher was observed with a service date of 10/23/23. First aid kit was observed and contained all required items.

The exterior tour of back yard was conducted and found to be free from debris. A covered outdoor seating area was observed for residents in care. Side gate was self-closing and self-latching.
SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Lisa Salazar
LICENSING EVALUATOR SIGNATURE: DATE: 11/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/07/2023
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: SIERRA SPRINGS RESIDENTIAL CARE
FACILITY NUMBER: 157204005
VISIT DATE: 11/07/2023
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(Continued from LIC 809)

Quarterly Emergency Disaster Drill logs were observed on 09/23/23 for staff. LPA observed on the LIC 610D (Emergency Disaster Plan) with emergency numbers and evacuations locations was posted in the entry. Facility files will be reviewed at a later date.

The following documents are requested and submitted to Fresno CCL by: 11/17/23: LIC9020, LIC 308, LIC 400, LIC 402, LIC 500, LIC 610D. An exit interview was conducted with Administrator. A copy of this report was discussed and provided at the time of visit. No deficiencies cited on today's visit.
SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Lisa Salazar
LICENSING EVALUATOR SIGNATURE:

DATE: 11/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/07/2023
LIC809 (FAS) - (06/04)
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