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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157208915
Report Date: 05/02/2024
Date Signed: 05/03/2024 12:17:32 AM


Document Has Been Signed on 05/03/2024 12:17 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:PALMS AT SAN LAUREN, THEFACILITY NUMBER:
157208915
ADMINISTRATOR:RICE, DOUGLASFACILITY TYPE:
740
ADDRESS:5300 HAGEMAN RDTELEPHONE:
(661) 218-8333
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93308
CAPACITY:68CENSUS: 67DATE:
05/02/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:15 PM
MET WITH:Doug Rice, Administrator TIME COMPLETED:
05:00 PM
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On 05/02/24, Licensing Program Analyst (LPA) L. Salazar arrived to the facility unannounced to conduct the required annual inspection, LPA was greeted by Administrator, stated the purpose of the visit and was allowed entry into the facility. Administrator on record is Doug Rice, Certificate #6053032740 Exp. 07/15/2025.

Facility census on this visit is 39 residents in Assisted Living and 28 residents in Memory Care. There are currently 10 residents receiving Hospice services and 4 residents are receiving Home Health Care services.

A tour of resident bedrooms were observed to have the required lighting and furnishings and were free from odor and any passageway obstruction / fire hazards. Facility temperature was 71 degrees F. LPA observed the required postings for Non-discrimination, Personal Rights of Residents in RCFE, Complaint Poster and facility's visitation policy.

Cleaning supplies were observed to be locked in a janitorial closet located in Memory Care. LPA toured the kitchen observed the required 7-day supply of non-perishable food and 2- day supply of fresh perishables to be properly stored. Menus for the facility were observed.

Carbon monoxide detectors were observed. Fire Extinguishers throughout the facility were observed with a service date of 04/01/24. First aid kits were observed to contain all required items.

LPA obtained facility roster (LIC 9020) and Personnel Summary (LIC500). Due to time restraint, LPA will review and return to facility to complete records review. No deficiencies cited on today's visit.

An exit interview was conducted with Administrator and a copy of this report were provided at the time of visit.
SUPERVISOR'S NAME: Melinda HoffmannTELEPHONE: (559) 341-3274
LICENSING EVALUATOR NAME: Lisa SalazarTELEPHONE: (559) 691-0004
LICENSING EVALUATOR SIGNATURE:
DATE: 05/02/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/02/2024
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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