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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157204176
Report Date: 07/24/2023
Date Signed: 07/24/2023 01:02:36 PM


Document Has Been Signed on 07/24/2023 01:02 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: 4DATE:
07/24/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:50 AM
MET WITH:Christina MarsyTIME COMPLETED:
01:15 PM
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On 7/24/23, Licensing Program Analyst (LPA) M. Medina made an unannounced Annual Required Inspection visit. LPA Medina introduced self, stated purpose of visit, and allowed entrance by Caregiver. Stephanie Haro, Administrator was not available for today's inspection. Christina Marsy contacted by telephone and arrived a short time later to conduct visit.

Currently, four (4) residents in care and present during today's visit. Facility tour began in resident bedrooms. Rooms observed to have all required accommodations. All areas of the facility have sufficient lighting. Residents bathrooms observed to be clean and in good repair. Bath/tub are have non-skid mats and grab bars. Hot water tested and measured at 117 degrees F. Dining room and living room have adequate seating and lighting for all residents in care. Tour of kitchen conducted. LPA observed adequate food supply for the residents in care. LPA observed leftovers stored in the refrigerator and/or freezer observed to be properly stored and labeled. Medications observed to be locked in small cabinet in laundry room, all medications have original labels and observed to be administered as prescribed.

Smoke Alarms tested & observed to be operational at time of visit. Carbon monoxide detector present and visible in hallway near resident bedrooms. Fire extinguisher has a service date of 9/13/22. Last fire drill conducted in 6/2023 according to facility records. All cleaning supplies observed to be locked in secured cabinet in laundry room.

All facility staff who require caregiver background checks have received criminal record index clearance or exemptions. Staff and resident files reviewed.

Outside areas toured. All exits open freely and observed to be free of obstruction. No hazards observed.

No deficiencies cited during visit.
SUPERVISOR'S NAME: Melinda HoffmannTELEPHONE: (559) 341-3247
LICENSING EVALUATOR NAME: Melinda MedinaTELEPHONE: (559) 410-5914
LICENSING EVALUATOR SIGNATURE:
DATE: 07/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/24/2023
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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