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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157206256
Report Date: 05/31/2023
Date Signed: 05/31/2023 11:21:37 AM

Document Has Been Signed on 05/31/2023 11:21 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:LIBERTY IN THE WESTFACILITY NUMBER:
157206256
ADMINISTRATOR:ERIC CORONADOFACILITY TYPE:
735
ADDRESS:15913 SAN MARCO PLTELEPHONE:
(661) 332-2949
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93314
CAPACITY: 4CENSUS: 4DATE:
05/31/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:12 AM
MET WITH:Administrator, Eric CoronadoTIME COMPLETED:
11:36 AM
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On 05/31/2023, Licensing Program Analyst (LPA) Walton arrived unannounced to conduct an annual inspection. LPA introduced self, stated the purpose of the visit and requested to meet with the Administrator. LPA met with Administrator, Eric Coronado. There are no residents present during today's inspection.

LPA conducted a tour of the facility with Administrator. During the inspection the facility appeared clean and odor free and at a comfortable temperature. Common areas were furnished and had adequate seating and lighting available. Resident bedrooms appeared clean and had required furnishings and adequate lighting. Residents bathrooms appeared clean, water temperature measured at 107.9 degrees F. Facility kitchen appeared to be clean and safe for food preparation. LPA observed 2-day supply of perishable foods and a 7-day supply of non-perishable food.

Exterior tour conducted, all exits open and free of obstructions on today’s visit. Fire extinguisher is current with a service date of 11/21/2022. Smoke detectors and carbon monoxide detector observed to operational. Last fire drill conducted 05/2023. Cleaning supplies observed to be locked in a cabinet. LPA reviewed resident records. LPA will return at a later date to review personnel records. Medications were observed to be administered as prescribed.

LPA is requesting the following documents be submitted to the Fresno CCL office by 06/14/2023: Current copy of Administrator Certificate, Designation of Facility Responsibility (LIC308), Administrator Organization (LIC 309), Affidavit regarding Client/Resident Cash Resources (LIC 400), Emergency and Disaster Plan, (LIC610D), Personnel Report (LIC500), Register of Facility Clients/Residents for (LIC9020), Surety Bond

No deficiencies issued. Exit interview conducted. A copy of this report was discussed and provided to Administrator, Eric Coronado, whose signature on this form confirms receiving this document.

SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Alexandria Walton
LICENSING EVALUATOR SIGNATURE: DATE: 05/15/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/15/2023
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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