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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157206783
Report Date: 08/07/2024
Date Signed: 08/07/2024 03:20:39 PM

Document Has Been Signed on 08/07/2024 03:20 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:VALLE BONITA HOMEFACILITY NUMBER:
157206783
ADMINISTRATOR/
DIRECTOR:
VILLEGAS, BEATRICEFACILITY TYPE:
735
ADDRESS:3912 FAIRMOUNT STREETTELEPHONE:
(661) 301-0809
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93306
CAPACITY: 4CENSUS: 4DATE:
08/07/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:45 AM
MET WITH:Administrator Beatrice VillegasTIME VISIT/
INSPECTION COMPLETED:
01:30 PM
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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 House Manager Henry Villegas. LPA met with Administrator Beatrice Villegas.

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 109 F.

Kitchen toured, supply of food observed and food stored properly for perishable and nonperishable. Knives were stored in a locked drawer. Medications were stored in a locked cabinet in the kitchen. Cleaning supplies were in a locked cabinet in the carport and in the bathroom. 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 07/02/24. Facility has a pull station fire alarm. Facility has a sprinkler system.

LPA observed a self latching gate on the outside of the residence.

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: 08/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/07/2024
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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