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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157204053
Report Date: 02/22/2022
Date Signed: 02/22/2022 05:11:10 PM

Document Has Been Signed on 02/22/2022 05:11 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:RANCH HOMEFACILITY NUMBER:
157204053
ADMINISTRATOR:MCCRAW, CHERYLFACILITY TYPE:
735
ADDRESS:6303 HIS WAYTELEPHONE:
(661) 323-4700
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93308
CAPACITY: 2CENSUS: 2DATE:
02/22/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:48 AM
MET WITH:Caregiver, Megan CannonTIME COMPLETED:
11:30 AM
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On 02/22/2022, Licensing Program Analyst (LPA) A. Walton arrived unannounced to conduct an Annual Inspection- Infection Control. LPA introduced self, stated the purpose of the visit and was granted entry to the facility. LPA requested to meet with Administrator. Facility staff contacted Administrator, Cheryl McCraw, LPA spoke with Administrator via telephone. Administrator is unable to attend this inspection and gave verbal permission for LPA to meet with Caregiver, Megan Cannon. There are 2 out of 2 residents present in the facility at this time. Facility has one central entrance and exit. Facility has implemented a screening/sign-in policy for visitors.

Facility appeared cleaned with no obstruction or fire clearance issues. Hand sanitizer was readily available to residents and visitors. Social distancing is maintained in the common and dining areas. Bathrooms have trash cans with a lid. Hand washing posters were observed by the bathroom sink in 2 out of 2 bathrooms. The facility has 2 bedrooms. Bedrooms are single occupant.

LPAs checked residents’ locked medications and observed a 30-day supply. Food supply was checked and there appeared to be an adequate supply. Cleaning and PPE supplies were checked. Facility staff was observed with mask on. Residents wear masks when away from the community

An Annual Continuation visit will be conducted on a later date to review resident and staff records.

No deficiencies issued. Exit interview conducted. A copy of this report will be provided via email due to COVID-19 precautionary measures. Report signed on-site by Facility Representative.

SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Alexandria Walton
LICENSING EVALUATOR SIGNATURE: DATE: 02/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/22/2022
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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