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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157208913
Report Date: 03/16/2022
Date Signed: 03/16/2022 10:57:42 AM


Document Has Been Signed on 03/16/2022 10:57 AM - 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:ADVENT RESIDENCE HOMEFACILITY NUMBER:
157208913
ADMINISTRATOR:ASIGNACION, JEANFACILITY TYPE:
740
ADDRESS:10114 STONEHAM STTELEPHONE:
(661) 695-9152
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93314
CAPACITY:6CENSUS: 5DATE:
03/16/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Administrator Jean AsignacionTIME COMPLETED:
11:00 AM
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Licensing Program Analyst LPA Shawna Doucette conducted an Annual Inspection on this date. LPA was met by Staff Arthur Asignacion and discussed the purpose of the visit. Administrator Jean Asignacion responded to the facility to conduct the visit. LPA and Administrator Jean Asignacion began the tour at the front entrance/office of the facility.

Facility does not have a mitigation plan. Staff does not have training for Covid.

Visitor log-in/temperature check, masks, and disinfection station was observed upon entry. Facility has one entrance/exit point. Hand sanitizer was readily available to residents and visitors. Social distancing is maintained in the common areas. Hand washing and other various Covid-19 related signs were observed in the common areas.

LPA observed a two day supply of perishable food and seven day supply of non-perishable food. Cleaning supplies were observed to be locked in a cabinet in the laundry room. LPA observed the following personal protective equipment; hand sanitizer, gloves, and masks. Facility needs gowns and face shields.

Resident’s files have updated emergency contact information.


Exit interview was conducted and a copy of this report was provided via email.
SUPERVISOR'S NAME: Sergiy PidgirnyTELEPHONE: (559) 650-7923
LICENSING EVALUATOR NAME: Shawna DoucetteTELEPHONE: (559) 580-4595
LICENSING EVALUATOR SIGNATURE:
DATE: 03/16/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/16/2022
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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