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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157204176
Report Date: 07/08/2024
Date Signed: 07/08/2024 04:17:27 PM


Document Has Been Signed on 07/08/2024 04:17 PM - 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: 2DATE:
07/08/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:56 PM
MET WITH:Stephanie Haro
Christina Marsy		TIME COMPLETED:
04:30 PM
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On 7/8/2024, Licensing Program Analyst (LPA) M. Medina conducted an unannounced Annual Required Inspection. LPA arrived, introduced self, stated purpose of visit, and allowed entrance by caregiver. Christina Marsy and Stephanie Haro contacted by telephone and arrived a short time later to conduct visit with LPA.

There are currently two residents in placement, residents observed to be relaxing in the living room watching television and reading the newspaper,

LPA observed facility to be clean, odor free, and temperature to be 77 degrees. Facility observed to be equipped with auditory alarms on exit doors. Resident rooms toured, and observed to have all required furnishings. All common areas observed to have adequate seating available for residents. Bathrooms observed to have grab bars, shower chairs, and non-skid mats available. Fixtures in the bathroom observed to be functional. Water temperature measured at 117 degrees F. Kitchen toured, facility has adequate food supply for the residents in care. Stove knobs observed to be off and secured. Knives observed to be locked and secured and inaccessible to residents. Medications observed to be locked and secured. Medications observed to have original labels, and to be administered as prescribed.

LPA observed smoke detectors and carbon monoxide detector to be operational during facility inspection. Last fire drill conducted in April 2024 according to facility records. Fire Extinguisher present with a service date on 10/10/2023.
SUPERVISOR'S NAME: Melinda HoffmannTELEPHONE: (559) 341-3247
LICENSING EVALUATOR NAME: Melinda MedinaTELEPHONE: (559) 410-5914
LICENSING EVALUATOR SIGNATURE:
DATE: 07/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/08/2024
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: MEADOWS, THE
FACILITY NUMBER: 157204176
VISIT DATE: 07/08/2024
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Outside of facility has shaded area and seating available for residents. No hazards observed.

Facility to submit the following documents to Fresno Regional Office no later than 7/19/22: LIC 309 (Administrative Organization), LIC 500 (Personnel Report), LIC 9020 (Register of Facility Clients/Residents), Copy of Liability Insurance.

Resident and Staff files reviewed.

Exit interview conducted. Report signed and a copy of facility report provided for facility records.
SUPERVISOR'S NAME: Melinda HoffmannTELEPHONE: (559) 341-3247
LICENSING EVALUATOR NAME: Melinda MedinaTELEPHONE: (559) 410-5914
LICENSING EVALUATOR SIGNATURE:

DATE: 07/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/08/2024
LIC809 (FAS) - (06/04)
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