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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157204166
Report Date: 11/16/2022
Date Signed: 11/17/2022 08:43:01 AM

Document Has Been Signed on 11/17/2022 08:43 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:SCOTT RESIDENTIAL, LLCFACILITY NUMBER:
157204166
ADMINISTRATOR:SCOTT, CYNTHIAFACILITY TYPE:
735
ADDRESS:1013 N. SIERRA VIEW STREETTELEPHONE:
(213) 590-9304
CITY:RIDGECRESTSTATE: CAZIP CODE:
93555
CAPACITY: 4CENSUS: 1DATE:
11/16/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:00 AM
MET WITH:Cynthia Scott, Licensee TIME COMPLETED:
11:50 AM
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On 11/16/22, Licensing Program Analysts (LPAs) L. Salazar and M. Medina arrived at the facility unannounced to conduct an Annual Infection Control inspection. LPAs were greeted by Licensee, stated the purpose of the visit and were allowed entry into the facility. COVID precautionary measures were taken at the time of entry. LPAs entered through the central entry point where hand sanitizer and visitor policy was posted.

Facility Mitigation plan has been submitted to CCL. Infection control procedures described in the plan which were observed and reviewed by LPAs include: Visitor sign in and symptoms screenings for visitors, quarantine/isolation procedures, emergency staffing plan. Licensee is identified as the Infection Control Lead for the facility.

LPAs toured the facility inside and out. All common areas of facility have adequate seating and lighting for resident in care. Facility has adequate food supply. Fire extinguisher present with a service date of 10/13/22. Carbon monoxide and smoke detectors present and observed observational during today's inspection. First Aid present with all required supplies.

Through LPAs' observations, documentation review and interview with Licensee, the required infection control practices are found to be in compliance. No deficiencies cited on todays visit.

A copy of this report was provided for facility records.
SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Lisa Salazar
LICENSING EVALUATOR SIGNATURE: DATE: 11/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/16/2022
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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