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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157206261
Report Date: 07/15/2022
Date Signed: 07/15/2022 10:10:46 AM

Document Has Been Signed on 07/15/2022 10:10 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:SAILS XFACILITY NUMBER:
157206261
ADMINISTRATOR:TUCKER, JACQUELINEFACILITY TYPE:
735
ADDRESS:7617 INDIAN GULCH STTELEPHONE:
(661) 473-2333
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93313
CAPACITY: 5CENSUS: 5DATE:
07/15/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:32 AM
MET WITH:Administrator Jacqueline “Jacki” TuckerTIME COMPLETED:
10:10 AM
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On 7/15/22, Licensing Program Analyst (LPA) M. Yang arrived unannounced to conduct an Annual Inspection - Infection Control. LPA introduced self, stated the purpose of the visit, and met with Administrator Jacqueline “Jacki” Tucker. There are currently four clients present during tour.

Upon entry facility staffs was observed with no facial covering. Visitor log-in/temperature check was observed upon entry. Hand sanitizer was readily available to clients and visitors. Facility has one entrance/exit point. Facility appeared cleaned with no obstruction or fire clearance issues. Social distancing is maintained in the common and dining areas. LPA observed social distancing and cough etiquette postings in facility.

Food supply was checked and appeared to be an adequate supply. LPA checked clients’ locked medications and observed a 30-day PPE supplies. LPA observed fire extinguisher served date: 4/22/22.

All clients’ room toured and observed to be adequately furnished and lit. LPA observed five bedrooms that are single occupant. Bathrooms observed trash bin with lid. LPA observed hand washing posting by all sinks. Cleaning supplies were stored and locked in cabinet in the laundry room.

The exterior tour was conducted. Side gate was self-closing and self-latching. Staff records were reviewed for good health and infection control training. All clients’ records reviewed to have updated emergency contact information.

No deficiencies issued during this inspection.

Exit Interview conducted. The following documents are requested and submitted to Fresno CCL by: 7/21/22. The following updated forms were requested: Lic 308, Lic 400, Lic 402, Lic 500, Lic 610D, Lic 9020, control of property and updated Administrator certificate.

A copy of this report was provided to the Administrator.

SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Mai Yang
LICENSING EVALUATOR SIGNATURE: DATE: 07/15/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/15/2022
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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