<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157208879
Report Date: 10/04/2022
Date Signed: 10/04/2022 03:33:04 PM

Document Has Been Signed on 10/04/2022 03:33 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:DONNELL COURTFACILITY NUMBER:
157208879
ADMINISTRATOR:DURAN, RONALDFACILITY TYPE:
735
ADDRESS:6609 DONNELL CTTELEPHONE:
(661) 412-8548
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93309
CAPACITY: 4CENSUS: 4DATE:
10/04/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:55 AM
MET WITH:Ronald Duran, AdministratorTIME COMPLETED:
01:30 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 10/4/22 at 10:55 AM, Licensing Program Analyst (LPA) Malia Thao arrived unannounced to conduct an annual inspection. LPA explained reason for inspection and was granted entry. LPA met with Administrator (ADM) Ronald Duran.

A tour of the facility was conducted. COVID-19 guidelines are in place. Facility has one main entrance/exit point. Facility was observed clean and without any obstructions. No fire clearance issues. Pool gate observed locked and inaccessible. Hand sanitizer was readily available to residents and visitors. Bedrooms were checked. Each resident has their own room. LPA checked residents’ medications and observed the month's supply. Cleaning and PPE supplies were checked. Administrator certification is valid.

No deficiencies cited during this inspection.

The following forms are to be submitted to CCL within 2 weeks:
LIC610D (new revision), LIC 400, LIC402

Exit interview conducted. A copy of this report was given to Administrator Ronald Duran, whose signature confirms receipt of this report.
SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Malia Thao
LICENSING EVALUATOR SIGNATURE: DATE: 10/04/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/04/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 5