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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157206735
Report Date: 11/16/2022
Date Signed: 11/16/2022 03:53:05 PM


Document Has Been Signed on 11/16/2022 03:53 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: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:
11/16/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Cristina Zamora, Licensee TIME COMPLETED:
04:15 PM
NARRATIVE
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On 11/16/22, Licensing Program Analysts' L. Salazar and M Medina arrived at the facility unannounced to conduct and Infection control inspection. During the inspection, LPAs observed Resident R1, Resident R2 and Resident R3 to be bedridden.

Based on LPAs' observation of resident's in care and records review, facility license reflects a bedridden fire clearance for 1 (one) resident in Room 1 only. There are currently 3 resident's in care that are bedridden.

In accordance with California Code of Regulations, Title 22, Division 6, Health and Safety Code, Chapter 3.2, Article 04, a deficiency is being cited on the attached 809-D. The poses an immediate risk to resident in care.

A violation regarding bedridden fire clearance warrants an immediate civil penalty in the amount of $500 to be assessed. See LIC 421IM.

An exit interview was conducted with licensee and plans of correction were reviewed and developed with the licensee. A copy of this report and appeal rights were discussed and provided to the licensee at the time of visit.

SUPERVISOR'S NAME: Melinda HoffmannTELEPHONE: (559) 341-3274
LICENSING EVALUATOR NAME: Lisa SalazarTELEPHONE: (559) 691-0004
LICENSING EVALUATOR SIGNATURE:
DATE: 11/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/16/2022
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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Document Has Been Signed on 11/16/2022 03:53 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1314 E SHAW AVE
FRESNO, CA 93710


FACILITY NAME: RIDGECREST HOME CARE
FACILITY NUMBER: 157206735

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 11/16/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
11/17/2022
Section Cited

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ยง1569.72 Residents requiring skilled nursing or intermediate care; bedridden residents
(c) Notwithstanding paragraph (2) of subdivision (a), bedridden persons may be admitted to, and
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remain in, residential care facilities for the elderly that secure and maintain an appropriate fire clearance. A fire clearance shall be issued to a facility in which one or more bedridden persons reside if ... (1) The fire safety requirements are met..
**This requirement was not met as evidenced by LPAs observation of residents in care and records review. Facility license has a fire clearance for 1 resident in care. Facility currently has 3 bedridden residents in care. This poses an immediate risk to residents in care. **Immediate Civil Penalty is hereby assessed in the amount of $500.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME: Melinda HoffmannTELEPHONE: (559) 341-3274
LICENSING EVALUATOR NAME: Lisa SalazarTELEPHONE: (559) 691-0004
LICENSING EVALUATOR SIGNATURE:
DATE: 11/16/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 11/16/2022
LIC809 (FAS) - (06/04)
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