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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157206706
Report Date: 09/11/2024
Date Signed: 09/11/2024 04:31:14 PM


Document Has Been Signed on 09/11/2024 04:31 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: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: 4DATE:
09/11/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:46 PM
MET WITH:Rosalie AdelanteTIME COMPLETED:
04:32 PM
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On 9/11/24, Licensing Program Analyst (LPA) M. Medina made an unannounced Annual Required Inspection visit. LPA Medina introduced self, stated purpose of visit, and allowed entrance by Caregiver. Rosalie Adelante, Administrator was contacted by telephone and arrived a short time later to conduct visit.

Currently, four (4) residents in care and present during today's visit. Facility tour began in resident bedrooms. Rooms observed to have all required accommodations. All areas of the facility have sufficient lighting. Residents bathrooms observed to be clean and in good repair. Showers have non-skid mats, grab bars, and shower chair available. Hot water tested and measured at 119 degrees F. Dining room and living room have adequate seating and lighting for all residents in care. Tour of kitchen conducted. LPA observed adequate food supply for the residents in care. LPA observed leftovers stored in the refrigerator and/or freezer observed to be properly stored and labeled. Medications observed to be locked in small file cabinets near dining room area. Medications reviewed, observed to have original labels and observed to be administered as prescribed.

Smoke Alarms tested & carbon monoxide observed to be operational at time of visit. Fire extinguisher has a service date of 3/04/24. Last fire drill conducted in 7/31/24 according to facility records. All cleaning supplies observed to be locked in secured in hallway closet.

All facility staff who require caregiver background checks have received criminal record index clearance or exemptions. Staff and resident files reviewed.

Outside areas toured. All exits open freely and observed to be free of obstruction. Pool is surround by locked gate and inaccessible to residents in care. 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: 09/11/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/11/2024
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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