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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157208853
Report Date: 10/10/2024
Date Signed: 10/10/2024 01:45:48 PM

Document Has Been Signed on 10/10/2024 01:45 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/
DIRECTOR:		SAYSON, SHANNONFACILITY TYPE:
735
ADDRESS:15730 STREBOR DRIVETELEPHONE:
(661) 695-9278
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93314
CAPACITY: 4CENSUS: 4DATE:
10/10/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:27 AM
MET WITH:Administrator, Shannon Sayson and Program Supervsior, Mark DavisTIME VISIT/
INSPECTION COMPLETED:
01:06 PM
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On 10/10/2024, 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. LPA was granted entry to the facility by facility staff. Administrator, Shannon Sayson arrived a short time later. LPA met with Administrator and Program Supervisor, Mark Davis.

LPA reviewed facility records and observed the following: Client files were observed to be complete. LPA reviewed personnel records. Emergency disaster plan was reviewed. Facility last conducted a fire drill on 09/16/2024. Medications were checked. Medications are locked an inaccessible to clients in care and administered as prescribed.

LPA conducted a tour of the facility with Administrator and Program Supervisor. Common areas and dining areas were furnished with adequate lighting. Client bedrooms were observed to have required furnishings and adequate lighting. Client bathrooms was toured and observed to be operational. Hot water measured at 108.7 degrees F. Facility kitchen toured. Kitchen appeared to be clean and safe for food preparation. LPA observed an adequate food supply. Fire extinguisher was last serviced on 02/01/2024. Smoke detector and carbon monoxide detector observed to be operational during today's inspection.

Exterior tour conducted. All exits were open and free from obstructions. No fire clearance issues observed during today's inspection. LPA observed the facility pool to be locked and inaccessible to clients.

No deficiencies issued during today's inspection.

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.

LPA is requesting the following documents be submitted to the Fresno CCL office by 10/24/2024: 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.
SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Alexandria Walton
LICENSING EVALUATOR SIGNATURE: DATE: 10/10/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/10/2024
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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