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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157207096
Report Date: 09/28/2023
Date Signed: 09/28/2023 11:56:05 AM


Document Has Been Signed on 09/28/2023 11:56 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: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: 4DATE:
09/28/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:28 AM
MET WITH:Sharon TungpalanTIME COMPLETED:
12:06 PM
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On 9/28/23, Licensing Program Analyst (LPA) M. Medina conducted an unannounced Annual Required Inspection visit. LPA arrived, introduced self, stated purpose of visit and allowed entrance by Caregiver. Licensee, Fe Tungpalan contacted by telephone and was unavailable to conduct today's inspection.

LPA conducted facility tour with Caregiver. Facility observed to be at a comfortable temperature and well lit. All residents observed to be in the living room area, relaxing and listening to music when facility inspection began. All resident bedrooms toured and observed to have required furnishings. Resident bathrooms, observed operational and to have grab bar, and non skid mats available. All common areas of the facility have adequate seating available for all residents in care. Kitchen toured, facility observed to have a 2-day supply of perishable and a 7-day supply of non-perishable food on site. Medication observed to be locked and secured in cabinets in dining room. First Aid kit present with all regulation items. All chemicals and cleaning supplies observed to be locked and secured in laundry room.

Fire extinguisher present with a service date of 7/3/23. Smoke detector and carbon monoxide detector observed operational during today's inspection. All exit doors observed to have auditory alarms.

Outside of facility toured. All exits open without obstruction. Outside shed observed locked and secured. No hazards observed.

No deficiencies observed. Exit interview conducted and a copy of this report provided for facility records.
SUPERVISOR'S NAME: Melinda HoffmannTELEPHONE: (559) 341-3247
LICENSING EVALUATOR NAME: Melinda MedinaTELEPHONE: (559) 410-5914
LICENSING EVALUATOR SIGNATURE:
DATE: 09/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/28/2023
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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