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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157208902
Report Date: 09/30/2022
Date Signed: 09/30/2022 01:52:06 PM

Document Has Been Signed on 09/30/2022 01:52 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:
09/30/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:10 PM
MET WITH:Licensee Tiffany Apple, RN via telephone TIME COMPLETED:
02:00 PM
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On 09/30/22, Licensing Program Analyst (LPA) L. Salazar arrived at the facility unannounced to conduct a case management visit based on self reported incident reports submitted by Licensee. LPA was greeted by caregiver, stated the purpose of the visit and was allowed entry into the facility COVID precautionary measures were taken at the time of entry. LPA spoke to Licensee via telephone who verified that S1 is authorized to sign reports.

LPA reviewed self reported incident report dated 09/22/22 regarding Resident R1. R1 was observed to be having problems with shortness of breath and syncope. Licensee sought emergency medical attention for R1 in a timely manner. R1 will be seen by a specialist (E.P) October 2, 2022. Licensee has completed a reassessment for R1 and provided training and education for facility staff to care for R1's condition. No deficiencies cited on today’s inspection.
SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Lisa Salazar
LICENSING EVALUATOR SIGNATURE: DATE: 09/30/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/30/2022
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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