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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157206735
Report Date: 01/31/2022
Date Signed: 02/01/2022 07:46:30 AM

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:RIDGECREST HOME CAREFACILITY NUMBER:
157206735
ADMINISTRATOR:ZAMORA, CRISTINAFACILITY TYPE:
740
ADDRESS:1028 KINNETT AVENUETELEPHONE:
(760) 463-1180
CITY:RIDGECRESTSTATE: CAZIP CODE:
93555
CAPACITY:5CENSUS: 5DATE:
01/31/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:45 PM
MET WITH:Cristina Villagen, Caregiver TIME COMPLETED:
02:15 PM
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Licensing Program Analysts'(LPAs') L. Salazar and D. Ayers arrived at the facility unannounced to conduct a required annual inspection. LPAs' met with caregiver Cristina Villagen and announced the purpose of the visit. LPAs' spoke with Administrator Cristina Zamora via telephone.

LPAs' toured the facility inside and outside. The facility was adequately furnished and lit throughout. All passageways and exits were clear and free from obstruction. The facility had multiple fire extinguishers with service tags. All smoke and carbon monoxide detectors were observed to be functional. LPAs' observed a two day supply of perishable food stuffs and a seven day supply of nonperishable food stuffs which were stored properly in the facility. The facility had a refrigerator in the garage with extra food stuffs. Medications were secured in a locked closet and appeared to be administered properly. LPA's toured resident bedrooms and bathrooms. Resident bedrooms were adequately furnished, and bathrooms have required secure grab bars and nonskid mats. Facility emergency/disaster plan was reviewed. LPAs' reviewed infection control guidelines and best practices with Administrator. LPAs observed 2 half bed rails on both sides of Resident R1's room. There is a Dr.'s order for half beds rails x2 . LPA issued a Technical Violation as the interpretation from Dr. is not cleared. LPA spoke to licensee, licensee will take R1 to Dr. for a reassessment and correct the order for the bed rail and ambulatory status.

No deficiencies cited during the inspection. Exit interview conducted. A copy of the report was provided via email.

SUPERVISOR'S NAME: Melinda HoffmannTELEPHONE: (559) -65-7914
LICENSING EVALUATOR NAME: Lisa SalazarTELEPHONE: (559) 691-0004
LICENSING EVALUATOR SIGNATURE:

DATE: 01/31/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/31/2022
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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