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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157204138
Report Date: 05/31/2022
Date Signed: 05/31/2022 10:43:24 AM

Document Has Been Signed on 05/31/2022 10:43 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:MISSION WELLS, INC.-HESKETHFACILITY NUMBER:
157204138
ADMINISTRATOR:HOUCK, HELENFACILITY TYPE:
735
ADDRESS:6205 HESKETH DRIVETELEPHONE:
(661) 324-3277
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93309
CAPACITY: 4CENSUS: 4DATE:
05/31/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Helen Houck, Licensee/AdministratorTIME COMPLETED:
11:00 AM
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On 5/31/2022 at 9:00 AM, Licensing Program Analyst (LPA) Malia Thao arrived unannounced to conduct an Annual inspection. LPA explained reason for inspection and was granted entry by staff. Licensee/Administrator Helen Houck arrived a short time later.

LPA conducted tour with staff and did not observed any obstructions. No fire issues observed. Hand sanitizer was readily available to residents and visitors. Social distancing is maintained in the common and dining areas. Hand washing posters were observed by the bathroom sinks. Bedrooms were checked and residents do not share bedrooms. LPA checked residents’ medications. Food supply was observed in adequate supply. Cleaning and PPE supplies were checked. Resident files have updated emergency contact information. Staff files checked for health assessments. Administrator certificate is valid.

No deficiencies cited during this inspection.

The following updated forms to be sent to CCL within 2 weeks:
LIC500, LIC400, LIC402, LIC610D (new revision)

Exit interview conducted. A copy of this report was given to Licensee Helen Houck, whose signature confirms receipt of this report.
SUPERVISORS NAME: Andy Xiong
LICENSING EVALUATOR NAME: Malia Thao
LICENSING EVALUATOR SIGNATURE: DATE: 05/31/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/31/2022
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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