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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157208826
Report Date: 12/13/2022
Date Signed: 12/14/2022 05:56:26 PM


Document Has Been Signed on 12/14/2022 05:56 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:SHERWOOD ELDERLY CARE FACILITYFACILITY NUMBER:
157208826
ADMINISTRATOR:BARAJAS, JUDITHFACILITY TYPE:
740
ADDRESS:2204 SHERWOOD AVETELEPHONE:
(661) 220-6647
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93304
CAPACITY:6CENSUS: 5DATE:
12/13/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:20 PM
MET WITH:Administrator, Judith BarajasTIME COMPLETED:
01:45 PM
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Licensing Program Analyst (LPA) Darius Wiliams conducted an unannounced Annual Inspection visit regarding infection control. LPA Williams met with Administrator, Judith Barajas and discussed the purpose of the visit.

LPA Williams toured the facility with the Administrator.

LPA Williams observed a visitor/temperature log, masks, and disinfection station at the front entrance. Facility has one entry and exit point. Social distancing is maintained in the common areas. Hand washing and other various Covid-19 related signs were observed in the common areas.

LPA Williams observed a two day supply of perishable food and seven day supply of non-perishable food. Cleaning supplies and medications were observed behind a locked cabinet. LPA Williams observed personal protective equipment in storage.

Staff have received training regarding Covid-19 infection control and mitigation. 5 of 5 resident’s files had updated emergency contact information.

LPA Williams requested the following documents be sent to the Department by 12/20/2022; personnel report (LIC 500) ,designation of facility responsibility (LIC 308), and administrator certificate.

No deficiencies were observed.

An exit interview was conducted and a copy of this report will be provided via e-mail.
SUPERVISOR'S NAME: Serigy PidgirnyTELEPHONE: (559) 246-0610
LICENSING EVALUATOR NAME: Darius WilliamsTELEPHONE: 559-243-8080
LICENSING EVALUATOR SIGNATURE:
DATE: 12/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/13/2022
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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