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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157208816
Report Date: 12/03/2021
Date Signed: 01/03/2022 03:06:04 PM

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:OAK MANOR CARE CENTERFACILITY NUMBER:
157208816
ADMINISTRATOR:BRANCH, BRIANNAFACILITY TYPE:
740
ADDRESS:9604 VALLEY FOREST CTTELEPHONE:
(661) 282-5200
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93311
CAPACITY:6CENSUS: 3DATE:
12/03/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:40 AM
MET WITH:Licensee, Brianna BranchTIME COMPLETED:
02:30 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
Licensing Program Analyst LPA L. Salazar conducted an Annual Inspection on this date. LPA was greeted by licensee and discussed the purpose of the visit. LPA and Licensee toured the facility inside and out.

Visitor log-in/temperature check, masks, and disinfection station was observed upon entry. Hand sanitizer was readily available to residents and visitors. Social distancing is maintained in the common areas. Hand washing and other various Covid-19 related signs were observed in the common areas. COVID Provider Information Notifications (PINS) will be maintained in a binder at the facility entrance.

LPA observed a two day supply of perishable food and seven day supply of non-perishable food. Cleaning supplies were observed in a locked in a cabinet in the kitchen. Medications are locked in a closet in the kitchen. LPA observed the following personal protective equipment in a hall closet; sanitizer, gloves, and masks. Staff records were reviewed for infection control training. LPA observed all facility staff wearing masks.

Exit interview was conducted and a copy of this report was provided. No deficiencies were observed.
SUPERVISOR'S NAME: Melinda HoffmannTELEPHONE: (559) -65-7914
LICENSING EVALUATOR NAME: Lisa SalazarTELEPHONE: (559) 691-0004
LICENSING EVALUATOR SIGNATURE:

DATE: 12/03/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/03/2021
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 1