<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157204053
Report Date: 03/29/2023
Date Signed: 03/29/2023 09:37:31 AM

Document Has Been Signed on 03/29/2023 09:37 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:RANCH HOMEFACILITY NUMBER:
157204053
ADMINISTRATOR:MCCRAW, CHERYLFACILITY TYPE:
735
ADDRESS:6303 HIS WAYTELEPHONE:
(661) 323-4700
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93308
CAPACITY: 2CENSUS: 2DATE:
03/29/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
07:45 AM
MET WITH:Cheryl McCrawTIME COMPLETED:
09:50 AM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 3/29/23, Licensing Program Analyst (LPA) M. Medina conducted an Annual Required Inspection. LPA introduced self and stated purpose of visit. LPA was allowed entrance by Direct Care Staff. Administrator Cheryl McCraw contacted by telephone and arrived a short time later to conduct inspection.

Residents attend Day Program Monday - Friday 8:30 am - 3:00 pm. One resident remained at facility during time of inspection.

Facility tour conducted. Facility observed to be clean and odor free. Adequate seating and lighting observed in both the living room and dining room. Client bedrooms have all required accommodations. Client bathroom toured, LPA measured water temperature 116 degrees F. Kitchen toured, LPA observed a 2-day supply of perishable food and a 7-day supply of non-perishable food. All knives and sharps observed to be in locked box in kitchen cabinet. Medications observed to be kept in a locked cabinet in the dining room. Medications were reviewed and observed to have their original labels and appear to be given as ordered. P & I reviewed and observed to accurate.

Smoke detectors and carbon monoxide observed to be operational during today's inspection. Fire extinguisher present and have a service date of 06/21/22. Last fire drill conducted on according to facility records.

Outside toured. No hazards observed. All fire exits clear of any obstructions.

Administrator to submit copy of Administrator's Certificate, CPR/First Aid card, updated LIC 500, LIC 610, LIC 9020 to Fresno CCL no later than 4/07/23.

No deficiencies cited during today's inspection.
SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Melinda Medina
LICENSING EVALUATOR SIGNATURE: DATE: 03/29/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/29/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1