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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157208902
Report Date: 05/20/2022
Date Signed: 06/21/2022 12:03:04 PM

Document Has Been Signed on 06/21/2022 12:03 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:TRU FOUNDATIONFACILITY NUMBER:
157208902
ADMINISTRATOR:APPLE, TIFFANYFACILITY TYPE:
735
ADDRESS:11509 TAGUS DRTELEPHONE:
(661) 472-3577
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93311
CAPACITY: 6CENSUS: 2DATE:
05/20/2022
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME BEGAN:
11:15 AM
MET WITH:Administrator Christopher Apple and Staff S1 TIME COMPLETED:
01:00 PM
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On 05/20/2022, Licensing Program Analyst (LPA) L. Salazar arrived at the facility unannounced to conduct a Health & Safety Inspection. LPA was greeted by Administrator and Staff S1, explained the purpose of the visit as was allowed entry. Covid precautionary measures were taken at the time of entry.

LPA toured the facility inside out. LPA observed 2 out 2 residents in care. LPA observed both residents in care to be comfortable and alert.

An incident report was received on 05/14/22 for Resident R1. R1 was eating in the kitchen when S1 was in the kitchen when they heard a fork drop and observed R1's face down on the kitchen table. S1 shook R1 to wake them. R1 responded and stated they were "okay" and "good". S1 did not observe any injuries on R1.

S1 observed R1 to appear light-headed. S1 guided R1 to a seated position and proceeded to contacted emergency services and Licensee. An ambulance arrived to the facility transport to hospital. LPA observed hospital discharge papers that include, negative diagnostic testing. R1 was diagnosed with syncope and released home with no new orders. Licensee is a Masters Science Administration, Health Care Management ( MSA-HCM), Bachelor Science Nursing (BSN) and Registered Nurse (R.N.) and has generated a Orthostatic Blood Pressure Measurement assessment to monitor R1 daily.

No deficiencies were cited during this visit. An exit interview was conducted with the Licensee
SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Lisa Salazar
LICENSING EVALUATOR SIGNATURE: DATE: 05/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/20/2022
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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