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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157206728
Report Date: 09/19/2022
Date Signed: 09/19/2022 09:40:10 AM

Document Has Been Signed on 09/19/2022 09:40 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:VALLEY RESIDENTIAL SERVICESFACILITY NUMBER:
157206728
ADMINISTRATOR:VILLEGAS, BEATRICEFACILITY TYPE:
735
ADDRESS:5808 EDGEMONT DRTELEPHONE:
(661) 832-0214
CITY:BAKERSFIELD, CASTATE: CAZIP CODE:
93309
CAPACITY: 4CENSUS: 4DATE:
09/19/2022
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
08:35 AM
MET WITH:Dawona Howard, Staff (DSP 1)TIME COMPLETED:
09:50 AM
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On 9/19/22 at 8:35 AM, Licensing Program Analyst (LPA) Malia Thao arrived unannounced to conduct a POC visit. LPA explained reason for inspection and was granted entry by staff. Licensee/Administrator Beatrice Villegas was available by telephone and gave permission for staff Dawona Howard to sign today's report.

LPA returned to inspect deficiency issued on 8/24/22. LPA observed bedroom #1 ceiling fan chain installed with new end pieces, making the chain reachable for resident; both sink faucets in hall bathroom and sink faucet in master bathroom were not replaced but were repaired so that water flow was steady and not spraying; tile wall surround in hall bathroom observed cleaned but yellow residue remained visible; and exterior fire exit gate observed replaced opening/closing with ease. Licensee advised the tile surround is cleaned every day with bleach to ensure no growth of bacteria.

Bedroom #4 door was observed with nails of top hinge screwed in, but the door was still sticking and not closing with ease. Door is not able to be closed without pulling the door hard to fit inside the door frame.

Civil penalties are being assessed for failure to correct CCR 80087(a) for the period of 9/17/22 through 9/19/22 (3 days) in the amount of $100 per day per citation, for a total of $300. A civil penalty of $100 per day per citation will continue until deficiency is corrected. See form LIC421FC for more detail.

Exit interview conducted. A copy of this report and appeal rights were given to staff Dawona Howard, whose signature confirms receipt of this report.
SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Malia Thao
LICENSING EVALUATOR SIGNATURE: DATE: 09/19/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/19/2022
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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