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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157204176
Report Date: 07/21/2022
Date Signed: 07/21/2022 10:40:59 AM


Document Has Been Signed on 07/21/2022 10:40 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:MEADOWS, THEFACILITY NUMBER:
157204176
ADMINISTRATOR:HARO, STEPHANIE LYNNFACILITY TYPE:
740
ADDRESS:10702 FOUR BEARSTELEPHONE:
(661) 589-5188
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93312
CAPACITY:6CENSUS: 6DATE:
07/21/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:40 AM
MET WITH:Stephanie HaroTIME COMPLETED:
10:51 AM
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On 7/21/2022, Licensing Program Analyst (LPA) M. Medina conducted an Annual Required Infection Control Inspection. LPA Medina met by Administrator, Stephanie Haro and stated the purpose of the facility visit. COVID-19 guidelines are in place. Visitor log-in/temperature check was observed upon entry. Facility has one entrance/exit point. Stephanie Haro, Administrator Certificate #6049449740, expires 8/26/22.

Five (5) residents present during today's inspection, one (1) resident was out in the community. LPA observed residents to be finishing up breakfast and some watching television in the living room. Tour of the facility conducted. Facility appeared cleaned with no obstruction or fire clearance issues. Hand sanitizer was readily available to residents and visitors. Bathrooms have trash cans with lid. Hand washing posters were observed by the bathroom sink. All residents have private bedrooms.

LPA observed residents’ to have a 30-day supply of medication available. PPE supplies were checked. Fire extinguisher present with a service date 8/26/2021. LPA observed carbon monoxide detectors to be operational during today's inspection. Facility is equipped with a pull station and strobe lights

No deficiencies were observed. Exit interview was conducted. Facility report signed on site. Administrator was provided a copy of report for facility records.
SUPERVISOR'S NAME: Melinda HoffmannTELEPHONE: (559) 341-3247
LICENSING EVALUATOR NAME: Melinda MedinaTELEPHONE: (559) 410-5914
LICENSING EVALUATOR SIGNATURE:
DATE: 07/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/21/2022
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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