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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157206892
Report Date: 04/28/2022
Date Signed: 04/28/2022 11:00:06 AM

Document Has Been Signed on 04/28/2022 11:00 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:RHONEFACILITY NUMBER:
157206892
ADMINISTRATOR:CRANDELL, ROBERTFACILITY TYPE:
735
ADDRESS:7001 RHONE DRIVETELEPHONE:
(661) 396-0465
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93308
CAPACITY: 4CENSUS: 4DATE:
04/28/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:53 AM
MET WITH:Administrator, Marvin KillianTIME COMPLETED:
11:05 AM
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On 04/28/2022, Licensing Program Analyst (LPA) Walton arrived unannounced to conduct an Annual Inspection-Infection Control. LPA introduced self, stated the purpose of the visit and was granted entry to the facility by Administrator, Marvin Killian. LPA met with Administrator. The facility has one central entry and exit and has implemented a sign in policy for visitors.

Facility appeared cleaned with no obstruction or fire clearance issues. Hand sanitizer was readily available to residents and visitors. Social distancing is maintained in the common and dining areas. Bathrooms have trash cans with lid. Hand washing posters were observed by the bathroom sink. Bedrooms are single occupant.

LPA checked residents’ locked medications and observed a 30-day supply. Food supply was checked and there appeared to be an adequate supply. Cleaning and PPE supplies were checked. Facility staff was observed with mask on. LPA reviewed resident records.

LPA is requesting the following documents be submitted to the Fresno CCL office by 05/12/2022 Current copy of Administrator Certificate, Designation of Facility Responsibility (LIC308), Administrator Organization (LIC 309), Affidavit regarding Client/Resident Cash Resources (LIC 400), Emergency and Disaster Plan (LIC610D), Personnel Report (LIC500), Register of Facility Clients/Residents for (LIC9020), Surety Bond

No deficiencies issued during this inspection.

Exit interview conducted with Administrator. A copy of this report was discussed and provided to Administrator, Marvin Killian, whose signature on this form confirms receipt of this document.

SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Alexandria Walton
LICENSING EVALUATOR SIGNATURE: DATE: 04/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/28/2022
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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