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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157206616
Report Date: 07/25/2024
Date Signed: 07/25/2024 03:09:41 PM

Document Has Been Signed on 07/25/2024 03:09 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:ST. THERESE ADULT RESIDENTIAL FACILITYFACILITY NUMBER:
157206616
ADMINISTRATOR/
DIRECTOR:		CASTILLO, MYRA CELESTEFACILITY TYPE:
735
ADDRESS:6909 COPPER CREEK WAYTELEPHONE:
(661) 589-6804
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93308
CAPACITY: 2CENSUS: 2DATE:
07/25/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:41 PM
MET WITH:Hilda GarcesTIME VISIT/
INSPECTION COMPLETED:
03:30 PM
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On 7/25/2024, Licensing Program Analyst (LPA) M. Medina conducted an unannounced Annual Required Inspection visit. LPA introduced self, stated purpose of visit and allowed entrance by direct care staff. LPA met with Licensees Anitpolo and Hilda Garces to conduct facility visit and tour.

Currently, two (2) residents in care, both were present during inspection. Residents attend day program 8:30 am to 1:00 pm due to excessive heat.

Interior and exterior of facility toured during visit. Facility temperature comfortable and facility is odor free. Resident bedrooms toured and have all required furnishings. Linens are clean and in good repair. Linen supply is adequate. Resident bathrooms toured, hot water temperature measured at 106 degrees F in bathroom. Kitchen toured, 2 day supply of perishable and 7 day supply on non-perishable food available for residents. All knives are locked and secured. Medications observed to be locked and secured in hallway closet. All medications observed to have original labels and to be administered as prescribed.

Fire extinguisher has a service date of 8/06/23. LPA observed smoke detectors and carbon monoxide detectors observational during facility inspection. First Aid kit observed to have all required items.

Outside of the facility toured. All exits open free of obstruction.

LPA will return at a later date to review staff and resident records.

No deficiencies cited during today's visit.
SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Melinda Medina
LICENSING EVALUATOR SIGNATURE: DATE: 07/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/25/2024
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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