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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157208853
Report Date: 11/13/2023
Date Signed: 11/13/2023 01:19:02 PM

Document Has Been Signed on 11/13/2023 01:19 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:STREBOR HOMEFACILITY NUMBER:
157208853
ADMINISTRATOR:SAYSON, SHANNONFACILITY TYPE:
735
ADDRESS:15730 STREBOR DRIVETELEPHONE:
(661) 695-9278
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93314
CAPACITY: 4CENSUS: 4DATE:
11/13/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:34 AM
MET WITH:Administrator, Shannon SaysonTIME COMPLETED:
01:33 PM
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On 11/13/2023, Licensing Program Analyst (LPA) Walton arrived unannounced to conduct an annual inspection. LPA introduced self, stated the purpose of the visit and requested to meet with the Administrator. Facility staff contacted Administrator, Shannon Sayson, who arrived a short time later. LPA met with Administrator.

LPA conducted a tour of the facility. During the inspection the facility appeared clean and odor free and at a comfortable temperature. Common areas were furnished and had adequate seating and lighting available. Resident bedrooms appeared clean. Residents bathroom appeared clean, water temperature measured at 110.9 degrees F. Facility kitchen appeared to be clean and safe for food preparation. LPA observed 2-day supply of perishable foods and a 7-day supply of non-perishable food.

Exterior tour conducted, all exits open and free of obstructions on today’s visit. Fire extinguisher is current with a service date of 09/11/2023. Smoke detectors and carbon monoxide detector observed to operational. Last fire drill conducted on 10/16/2023. Cleaning supplies observed to be locked and inaccessible to residents in care. LPA reviewed client and staff files. Medications and MARs were reviewed. Medications observed to be locked and inaccessible to clients.

LPA is requesting the following documents be submitted to the Fresno CCL office by 11/27/2023: Current copy of Administrator Certificate, Designation of Facility Responsibility (LIC308), Administrator Organization (LIC 309), Affidavit regarding Client/Resident Cash Resources (LIC 400),Emergency and Disaster Plan (LIC610D), Personnel Report (LIC500), Register of Facility Clients/Residents for (LIC9020), Surety Bond.

No deficiencies issued during today's visit. Exit interview conducted. A copy of this report was discussed and provided to Administrator, Shannon Sayson, whose signature on this form confirms receipt of this document.

SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Alexandria Walton
LICENSING EVALUATOR SIGNATURE: DATE: 11/13/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/13/2023
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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