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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157207096
Report Date: 08/08/2024
Date Signed: 08/08/2024 04:21:34 PM


Document Has Been Signed on 08/08/2024 04:21 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: 5DATE:
08/08/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:06 PM
MET WITH:Fe Tungpalan, Licensee/AdministratorTIME COMPLETED:
04:22 PM
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On 7/23/24, Licensing Program Analyst (LPA) M. Medina conducted an unannounced Annual Required Inspection. LPA arrived, introduced self, and allowed entrance by direct care staff. Administrator, Fe Tungpalan contacted by telephone and arrived a short time later to conduct visit.

Facility tour conducted. Facility observed to be clean, odor free, comfortable temperature, and well lit. Facility living room, dining room, and family all observed to have adequate seating available. Resident bedrooms toured, all bedrooms observed to have all required furnishings. Resident bathrooms toured, water temperature measured at 117 degrees F. Bathrooms observed to have grab bars in the shower and near toilet. Shower also has shower chair and non-skid mat available. LPA observed kitchen to have all sharp locked and secured in kitchen drawers. Facility observed to have a 2-day supply of perishable food and a 7-day supply of non-perishable food available. Medications are centrally stored and locked. All medications observed to have original labels and be administered as prescribed.

Outside toured. All exits open free of obstruction. No hazards observed.

Fire extinguisher present with a service date of 7/23/24. Smoke and Carbon Monoxide detectors present and observed operational. Last Fire drill conducted 6/22/2024 according to facility records.

LPA reviewed resident and staff files. LPA requested the following forms to be submitted to Fresno Regional Office no later than 8/22/24: Copy of Administrator Certificate, Personnel Report (LIC500), Client Roster (LIC 9020), and current liability insurance.

No deficiencies were cited during this inspection. Exit interview was 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: 08/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 08/08/2024
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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