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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157207096
Report Date: 08/02/2022
Date Signed: 08/02/2022 01:53:56 PM


Document Has Been Signed on 08/02/2022 01:53 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:WINDCREEK SENIOR CAREFACILITY NUMBER:
157207096
ADMINISTRATOR:TUNGPALAN, FE V.FACILITY TYPE:
740
ADDRESS:9300 WINDCREEK CT.TELEPHONE:
(661) 387-6582
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93312
CAPACITY:6CENSUS: 6DATE:
08/02/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:49 AM
MET WITH:Fe TungpalanTIME COMPLETED:
01:35 PM
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On 8/02/22, Licensing Program Analyst (LPA) M. Medina conducted an unannounced Annual Required Inspection visit. LPA Medina introduced self and allowed entrance by Licensee/Administrator, Fe Tungpalan and discussed the purpose of the visit.

LPA Medina observed COVID protocols in place, visitor/temperature log, masks, gloves, and disinfection station at the front entrance. Facility has one entry and exit point. Social distancing is maintained in the common areas. Facility has hand washing and COVID-19 posters signs throughout facility. All facility staff observed to be wearing face masks.

LPA Medina observed residents to be watching television in the living room, having lunch, and some resting. Resident bedrooms toured, all beds have a minimum of 6 feet between them. Bathrooms have hand soap and paper towels available. Facility has a 2-day supply of perishable food and 7-day supply of non-perishable food available. Medications observed to be locked and secured in cabinet in dining room. Facility has a supply of Personal Protective Equipment (PPE) on hand: gowns, face shield, gloves, masks, head covers, and shoe covers.

Fire extinguisher present with a service date of 7/22/22. Facility is equipped with a pull station and auditory alarms. Carbon monoxide and smoke detectors observed to be operational during today's inspection.

No deficiencies were observed.

Exit interview was conducted and a copy of this report was provided for facility records.
SUPERVISOR'S NAME: Melinda HoffmannTELEPHONE: (559) 341-3247
LICENSING EVALUATOR NAME: Melinda MedinaTELEPHONE: (559) 410-5914
LICENSING EVALUATOR SIGNATURE:
DATE: 08/02/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/02/2022
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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