157206783-8-19-2023-24-AS-SDOE-CUUPUB-20230819113718

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 157206783
Report Date: 08/19/2023
Date Signed: 08/19/2023 11:37:27 AM

Document Has Been Signed on 08/19/2023 11:37 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:	VALLE BONITA HOME		FACILITY NUMBER:	157206783
ADMINISTRATOR:	VILLEGAS, BEATRICE		FACILITY TYPE:	735
ADDRESS:	3912 FAIRMOUNT STREET		TELEPHONE:	(661) 301-0809
CITY:	BAKERSFIELD	STATE: CA	ZIP CODE:	93306
CAPACITY: 4		CENSUS: 4	DATE:	08/19/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:05 AM
MET WITH:	Staff Rachel Villasana and Administrator Henry Villegas and Administrator Beatrcie Villegas		TIME COMPLETED:	11:45 AM

NARRATIVE

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Licensing Program Analyst (LPA) Shawna Doucette arrived at the facility unannounced to conduct the Required Annual Inspection. LPA disclosed the purpose of the inspection and was granted entry into the facility by Staff Rachel Villasana. Staff contacted Administrator Beatrice Villegas who advised Administrator Henry Villegas would respond to assist with the visit. LPA disclosed the purpose of the inspection and was granted entry into the facility by the Administrator.

A tour of the facility was conducted with the Administrator. The residence was set at 77 F temperature and free of passageway obstructions inside and outside.

LPA Doucette observed 4 bedrooms in the residence. Residents' rooms were toured and inspected. Rooms were found to be clean. Hot water temperature was measured 112.6 F.

Kitchen toured, supply of food observed and food stored properly for perishable and nonperishable. Knives were stored in a locked closet. Medications were stored in a locked Medication closet. Cleaning supplies were in a locked cabinet. Smoke detectors and carbon monoxide detectors were checked and operating. Fire extinguishers were charged and had service dates of 3/31/23. Fire drill was last completed on 05/23. Facility has a pull station fire alarm. Facility has a sprinkler system.

LPA observed a self latching gate on the outside of the residence. There was outdoor seating for the residents.

Resident, medication and staff records were reviewed and found to be complete. Current first aid and CPR were on file for staff.

An exit interview was conducted with the Administrator. A copy of this report was discussed and left with the Administrator.

SUPERVISORS NAME: Sergiy Pidgirny
LICENSING EVALUATOR NAME: Shawna Doucette
LICENSING EVALUATOR SIGNATURE:	DATE: 08/19/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/19/2023

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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