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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 03:29:37 PM


Document Has Been Signed on 11/16/2022 03:29 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:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:19 PM
MET WITH:Christina ZamoraTIME COMPLETED:
03:35 PM
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Licensing Program Analysts (LPAs) M. Medina and L.Salazar arrived at the facility unannounced to conduct an Annual Required Infection Control Inspection. LPA allowed met at entrance by caregiver Cristina Villagen and announced the purpose of the visit. LPAs met with Administrator Cristina Zamora via telephone.

LPAs' toured, residents observed to be watching TV in the living room, resting in their bedrooms, and visiting with family. All common areas of the facility have adequate seating and lighting for all residents in care. Resident bedrooms have all required furnishings. Resident bathrooms toured. Bathrooms have grab bars near toilet, showers have grab bars, non-skid mats, and shower chairs available. LPA's observed a 2-day supply of perishable and a 7-day supply of non-perishable food available. Fire extinguisher present with a service date of 2/22/2022.

Outside toured. All exits open free of obstruction. No hazards observed.

Deficiencies observed during Infection Control visit will be documented in a separate Case Management report by LPA L. Salazar.

Due to time constraints this Inspection will require an Annual Continuation.

Exit interview conducted. A copy of this report was provided to Administrator for facility records.

SUPERVISOR'S NAME: Melinda HoffmannTELEPHONE: (559) 341-3247
LICENSING EVALUATOR NAME: Melinda MedinaTELEPHONE: (559) 410-5914
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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