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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157208251
Report Date: 08/16/2022
Date Signed: 08/16/2022 10:03:20 AM

Document Has Been Signed on 08/16/2022 10:03 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:FREISE HOPE HOUSEFACILITY NUMBER:
157208251
ADMINISTRATOR:OLLIVIER, REBECCA AFACILITY TYPE:
772
ADDRESS:721 8TH STTELEPHONE:
(661) 326-9700
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93304
CAPACITY: 14CENSUS: 10DATE:
08/16/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Staff Ron CordyTIME COMPLETED:
10:00 AM
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Licensing Program Analyst LPA Shawna Doucette conducted an Annual Infection Inspection on this date. LPA was met by Staff Ron Cordy and discussed the purpose of the visit. Administrator Tiffany Bell was not available to assist with the visit. The facility has a mitigation plan however it is not on the LIC 808. Staff Ron Corby will submit the LIC 808 and change of Administrator documents to CCL by 8/26/22.

Visitor log-in/temperature check, masks, and disinfection station was observed upon entry. Facility has one entrance/exit point. Hand sanitizer was readily available to residents and visitors. Social distancing is maintained in the common areas. Covid-19 related signs were observed in the common areas.

Facility has a two day perishable and a seven day non perishable supply of food. Cleaning supplies were observed locked in closet in the laundry room. LPA observed the following personal protective equipment in office; gowns, gloves, face shields, hand sanitizer and masks.

LPA observed all facility staff to be wearing masks upon arrival.

Resident’s files have updated emergency contact information. LPA's reviewed staff training for Covid.


Exit interview was conducted and a copy of this report was provided
SUPERVISORS NAME: Sergiy Pidgirny
LICENSING EVALUATOR NAME: Shawna Doucette
LICENSING EVALUATOR SIGNATURE: DATE: 08/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/16/2022
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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