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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157208826
Report Date: 12/13/2023
Date Signed: 12/13/2023 11:01:42 AM


Document Has Been Signed on 12/13/2023 11:01 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: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: 6DATE:
12/13/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Administrator Judith BarajasTIME COMPLETED:
11:00 AM
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LPA Shawna Doucette arrived at the facility unannounced to conduct an annual inspection. LPA was granted entry by Staff Roxanne Aguirre. LPA explained the purpose of the visit and staff contacted Administrator Judith Barajas who responded to the facility to assist with the visit.

A tour of the facility was conducted with the Administrator. The residence was set at 77 F temperature and free of passageway obstructions inside and outside.

Kitchen toured, supply of food observed and food stored properly for perishable and nonperishable. Medications were stored in a locked medication cart in the kitchen. Cleaning supplies were locked in a cabinet under the kitchen sink. Smoke detectors and carbon monoxide detectors were checked and operating. Fire extinguisher was last serviced 12/5/23. LPA checked water temperature which measured at 110.8 F. Fire drill was last conducted 12/1/23.

Resident, medication and staff records were reviewed. Current first aid and CPR were reviewed.

A copy of this report was provided to the Administrator.

SUPERVISOR'S NAME: Sergiy PidgirnyTELEPHONE: (559) 246-0610
LICENSING EVALUATOR NAME: Shawna DoucetteTELEPHONE: (559) 580-4595
LICENSING EVALUATOR SIGNATURE:
DATE: 12/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/13/2023
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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