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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157204053
Report Date: 02/21/2024
Date Signed: 02/26/2024 10:16:38 AM

Document Has Been Signed on 02/26/2024 10:16 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: DATE:
02/21/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:45 AM
MET WITH:TIME COMPLETED:
04:00 PM
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On 02/21/24, Licensing Program Analyst (LPA) L. Salazar arrived to the facility unannounced to conduct the required Annual Inspection Visit. LPA was greeted by Direct Support Personnel (DSP),stated the purpose of the visit and was allowed entry into the facility. DSP provided a tour of the facility inside and out while LPA waited for Administrator, who arrived to the facility shortly after LPA's arrival. Administrator on record is Ch, Certificate# 601610735, Exp. 05/24

LPA observed 1 resident in care at the time of visit, 2nd resident was in day program at the time if visit. Facility is a 2 bedroom 2 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 69 degrees F.

Bathrooms were toured and observed to have operational lights, running water, and non- slip floors. Hot water temperature tested at 116 degrees F. Trash can with lid and hand washing postings were observed.

Medications were observed to be locked in an upper cabinet located in the dining area. Cleaning supplies were observed to be locked in 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 05/12/23. First aid kit was observed and contained all required items. Internet devices and a working phone line were observed to be available for residents in care.
SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Lisa Salazar
LICENSING EVALUATOR SIGNATURE: DATE: 02/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/21/2024
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: RANCH HOME
FACILITY NUMBER: 157204053
VISIT DATE: 02/21/2024
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(Continued from 809)

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.

A sample of Resident files were reviewed and observed to have update emergency contacts, Admission agreement, individual performance plans (IPP). A sample of staff files were also reviewed. Quarterly Emergency Disaster Drill logs were observed for staff on.

The following documents are requested and submitted to Fresno CCL by: 03/17/24:
LIC 308, LIC309 (If Applicable) LIC 400, LIC 402, LIC 500, LIC 610D, Copy of current Administrator certificate and Emergency and Disaster Plan.

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: 02/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/21/2024
LIC809 (FAS) - (06/04)
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