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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157208902
Report Date: 06/21/2022
Date Signed: 06/21/2022 01:30:48 PM

Document Has Been Signed on 06/21/2022 01:30 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:
06/21/2022
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME BEGAN:
12:00 PM
MET WITH:Tiffany Apple, Licensee TIME COMPLETED:
01:45 PM
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On 06/21/2022, 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 residents in care at the time of arrival. Resident R1 was in the process of leaving the facility for a 5 day vacation with family and Resident R2 was in the living room watching TV.

Facility submitted a self reported incident report on 06/07/22 which documented recent behaviors of R1. No physical contact was made and behaviors were towards staff members only. No physical contact was made.

Facility has provided several resources for de-escalation purposes including a stationary bicycle in the living room, daily walks, community outings, 5- foot Pac man Arcade game for memory and fine motor skills, interactive board games, outdoor gardening supplies and equipment, basketball, karaoke machine, dancing and musical instruments.

Exit Interview conducted, no deficiencies cited on today's inspection.
SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Lisa Salazar
LICENSING EVALUATOR SIGNATURE: DATE: 06/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/21/2022
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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