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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157206706
Report Date: 10/18/2023
Date Signed: 10/19/2023 08:07:47 AM


Document Has Been Signed on 10/19/2023 08:07 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:
10/18/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Rosalie AdelanteTIME COMPLETED:
03:38 PM
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On 10/18/23, Licensing Program Analyst (LPA) M. Medina conducted an unannounced Annual Required Inspection. LPA introduced self and stated purpose of visit, LPA allowed entrance by Direct Care Staff. Administrator, Rosalie Adelante contacted by telephone and arrived a short time later to conduct facility inspection. Rosalie Adelante, Administrator Certificate #6001128740, expires 6/12/2025.

All residents present during today's inspection. Residents observed to be relaxing watching television or visiting with family members at time of inspection. Facility observed to be clean, odor free and a comfortable temperature. All common areas have sufficient seating and lighting for residents in care. Resident bedrooms observed to have all required furnishings. Residents bathrooms toured and observed to be clean and operational, 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. All knives are locked and secured in kitchen drawer. Medications observed to be locked, secured and administered as prescribed.

Smoke detectors and carbon monoxide observed to be operational during today's inspection. Fire extinguisher present with a service date of 11/28/22. Water temperature measured at 107 degrees F during facility inspection.

Outside toured. All exits open free 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: 10/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/18/2023
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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