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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157204034
Report Date: 07/21/2022
Date Signed: 07/21/2022 12:20:13 PM


Document Has Been Signed on 07/21/2022 12:20 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:M & L RESIDENTIAL HOMEFACILITY NUMBER:
157204034
ADMINISTRATOR:SALON, LEONIDAFACILITY TYPE:
740
ADDRESS:609 WANSTEAD LANETELEPHONE:
(661) 588-7784
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93312
CAPACITY:6CENSUS: 6DATE:
07/21/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:06 AM
MET WITH:Leonida SalonTIME COMPLETED:
12:37 PM
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On 7/21/22, Licensing Program Analyst (LPA) M. Medina conducted an Annual Required-Infection Control Inspection. LPA was met by Administrator, Leonida Salon and and stated the purpose of the visit. Leonida Salon's Administrator Certificate #6020049740, expires 11/27/22. LPA observed COVID-19 guidelines to be in place. Visitor log-in/temperature check was observed upon entry. Facility has one entrance/exit point. Staff observed to be wearing masks in facility and hand sanitizer observed to be readily available for residents and visitors.

Facility appeared cleaned with no obstruction or fire clearance issues. Social distancing is maintained in all common areas of the facility. Bathrooms have trash cans with lid. Hand washing posters were observed by the bathroom sink. Resident bedrooms toured, resident bedrooms have a minimum of 6 feet between beds.

LPA observed resident's to have a 30-day supply of medication available. Food supply is adequate for resident's in care. Cleaning supplies are locked and secured in garage. PPE supplies are available.

No deficiencies cited during today's inspection.

Exit interview was conducted. Report signed by Administrator and a copy of report provided for facility records.
SUPERVISOR'S NAME: Melinda HoffmannTELEPHONE: (559) 341-3247
LICENSING EVALUATOR NAME: Melinda MedinaTELEPHONE: (559) 410-5914
LICENSING EVALUATOR SIGNATURE:
DATE: 07/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/21/2022
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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