<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157206898
Report Date: 01/09/2024
Date Signed: 01/09/2024 12:24:42 PM

Document Has Been Signed on 01/09/2024 12:24 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:SPRUCE GARDENSFACILITY NUMBER:
157206898
ADMINISTRATOR:STEPHANIE HAROFACILITY TYPE:
740
ADDRESS:13303 NANTUCKET PLACETELEPHONE:
(661) 829-2703
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93314
CAPACITY: 6CENSUS: 2DATE:
01/09/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:47 AM
MET WITH:Administrator, Stephanie HaroTIME COMPLETED:
12:39 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 01/09/2024, Licensing Program Analyst (LPA) Walton arrived unannounced to conduct a case management visit. LPA introduced self, stated the purpose of the visit and requested to meet with the Administrator. LPA was granted entry to the facility. Facility staff contacted Administrator, Stephanie Haro. Administrator arrived a short time later.

The purpose of today's visit is to follow up on an incident that was reported to the Fresno CCL office. It was reported that on 11/08/2023 at approximately 9:00AM, R1 was observed by Administrator in the backyard. A short while later, the Administrator was informed, by the gardener, that the side gate was open and R1 was no longer in the backyard. Administrator informed Supervisor (SP) of the situation. SP utilized a vehicle to search for R1. R1 was found approximately 20 minutes later. During today's visit, LPA reviewed records. Upon review of records, it was revealed that R1 is not able to leave the facility unassisted. However, on 11/08/2023, R1 was without supervision and unassisted for approximately 20 minutes when R1 was able to exit out the facility's side gate.

A deficiency is being cited in accordance to California Code of Regulations, Title 22, Division 6 on the attached 809D.

Exit interview conducted and a plan of correction was reviewed and developed with Administrator. A copy of this report and appeal rights were discussed and provided to Administrator, Stephanie Haro, whose signature on this form confirms receipt of this document.
SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Alexandria Walton
LICENSING EVALUATOR SIGNATURE: DATE: 01/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/09/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 2
Document Has Been Signed on 01/09/2024 12:24 PM - It Cannot Be Edited


Created By: Alexandria Walton On 01/09/2024 at 12:07 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1314 E SHAW AVE
FRESNO, CA 93710

FACILITY NAME: SPRUCE GARDENS
FACILITY NUMBER: 157206898

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/09/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
01/09/2024
Section Cited
HSC
1569.312(a)

1
2
3
4
5
6
7
Every facility required to be licensed under this chapter shall provide at least the following basic services:
(a) Care and supervision as defined in Section 1569.2. This requirement was not met as evidenced by:
1
2
3
4
5
6
7
Facility conducted a reappriasal for R1 and determined that R1 needed a higher level of care. R1 was assigned a one on one caregiver. POC cleared during inspection.
8
9
10
11
12
13
14
Based on interviews and records review, Licensee did not ensure the requirements for section 1569.312 were met when on 11/08/2023, R1 was able to exit the facility out of the side gate and was without supervision/assistance for approximately 20 mintues, which is an immediate health and saftey risk to persons in care.
8
9
10
11
12
13
14

1
2
3
4
5
6
7
1
2
3
4
5
6
7

1
2
3
4
5
6
7
1
2
3
4
5
6
7
Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Melinda Hoffmann
LICENSING EVALUATOR NAME:Alexandria Walton
LICENSING EVALUATOR SIGNATURE:
DATE: 01/09/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/09/2024


LIC809 (FAS) - (06/04)
Page: 2 of 2