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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157206706
Report Date: 11/17/2022
Date Signed: 11/18/2022 08:14:59 AM


Document Has Been Signed on 11/18/2022 08:14 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:A & A BAKERSFIELD CARE HOMEFACILITY NUMBER:
157206706
ADMINISTRATOR:OBCEMEA, ROSALIEFACILITY TYPE:
740
ADDRESS:12203 EL CAPITAN AVE.TELEPHONE:
(661) 374-6633
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93312
CAPACITY:6CENSUS: 6DATE:
11/17/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:51 PM
MET WITH:Loriza SagumTIME COMPLETED:
04:30 PM
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On 11/17/22, Licensing Program Analyst (LPA) M. Medina conducted an unannounced Annual Required Inspection on this date. LPA allowed entrance by Direct Care Staff, and stated purpose of visit. Administrator, Rosalie Obcemea contacted by telephone and was not available for today's inspection. Rosalie Obcemea, Administrator Certificate #6001128740, expires 6/12/2023.

All COVID precautionary measures observed. Facility has a screening/visitor sign-in, thermometer, hand sanitizer, and masks available upon entry. Facility staff observed to be wearing masks.

All residents present during today's inspection. Residents observed to be relaxing watching television at time of inspection. Facility toured, all residents have required furnishings. All common areas of the facility have sufficient lighting and seating available. Residents bathrooms observed to be clean and in good repair. Bath/tub are have non-skid mats and grab bars. Tour of kitchen conducted. LPA observed a 2-day supply of perishable and a 7-day supply of non-perishable food available. Medications observed to be locked in small cabinets in dining room area.

Smoke detectors and carbon monoxide observed to be operational during today's inspection. All cleaning supplies observed to be locked and secured in hallway closet.

Outside toured. All exits open free of of obstruction. Pool is surrounded by a locked gate and inaccessible to residents. 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: 11/17/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/17/2022
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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