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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157206771
Report Date: 06/21/2023
Date Signed: 06/21/2023 11:06:11 AM

Document Has Been Signed on 06/21/2023 11:06 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:SAILS APPLETREEFACILITY NUMBER:
157206771
ADMINISTRATOR:JACQUELINE D. TUCKERFACILITY TYPE:
735
ADDRESS:11611 SAN MINIATO AVETELEPHONE:
(661) 570-3035
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93312
CAPACITY: 5CENSUS: 4DATE:
06/21/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:18 AM
MET WITH:Jacqueline D. TuckerTIME COMPLETED:
11:14 AM
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On 6/21/2023, Licensing Program Analyst (LPA) M. Medina conducted an unannounced Annual Required Inspection. LPA Medina allowed entrance by House Manager. Jacqueline Tucker, Administrator was present during facility inspection.

Currently, 4 residents are in placement. All residents were at Day Program at time of inspection. Residents attend day program Monday through Friday 8:00 am - 3:30 pm.

Facility tour conducted with Administrator. Facility observed to be well lit, clean and odor free. All common areas have adequate seating available. Resident bedrooms toured, all bedrooms observed to have required furnishings. Bathrooms toured, showers observed to have non-slid mats and grab bars. Water temperature during facility inspection measured at 113 degrees F. Kitchen toured, all sharps observed to be locked and secured in lock box. Facility observed to have a 2-day supply of perishable and 7-day of non-perishable available. Medication observed to be locked and secured in medication cabinet. Medication observed to be administered as ordered. Smoke detectors and carbon monoxide detector observed operational during inspection. Fire extinguisher present with a service date of 4/23/23.

Outside of facility toured. All exits open free of obstruction. Perimeter of back yard is secured with a fence and free of obstruction. Chemicals are locked and secured in garage.

Exit interview conducted. No deficiencies cited.
SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Melinda Medina
LICENSING EVALUATOR SIGNATURE: DATE: 06/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/21/2023
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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