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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 01:46:46 PM

Document Has Been Signed on 10/10/2024 01:46 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:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:08 PM
MET WITH:Administrator, Shannon Sayson and Program Supervsior, Mark DavisTIME VISIT/
INSPECTION COMPLETED:
02:01 PM
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On 10/10/2024, Licensing Program Analyst (LPA) Walton arrived unannounced to conduct a case management visit. LPA introduced self, stated the purpose of the visit and requested to meet with the Administrator. LPA met with Administrator and Program Supervisor, Mark Davis.

The purpose of today's visit is to follow up on an incident that was reported to the Fresno CCL office on 10/01/2024. It was reported that on 09/28/2024 and 09/29/2024, C1 missed a medication due to the facility administering the last medication on 09/27/2024. Interviews conducted with Administrator, Shannon Sayson and Program Supervsior, Mark Davis revealed the following: On 09/10/2024, the pharmacy contacted Administrator and the Administrator was informed that the pharmacy will be submitting an alternative medication request to the physician. Administrator followed up with the pharmacy on 09/25/2024. Administrator was informed that the physician had not responded to the request, due to the physician office being closed. On 09/27/2024, Program Supervisor went to the physician office and observed that the office was closed. On 09/30/2024, Program Supervisor returned to the physician office and obtained an emergency supply of the medication.

No deficiency issued during today's inspection.

During the exit interview, LPA discussed that a deficiency will not be issued due to a miscommunication/error with the physician and pharmacy. LPA requested the facility to develop an emergency plan to be proactive in the future to ensure that this incident does not occur in the future and that the facility will ensure that all clients will receive their medications as prescribed.

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: 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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