157208915-4-17-2023-24-AS-LSAR-CQYNQT-20230417104026

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 157208915
Report Date: 04/14/2023
Date Signed: 04/17/2023 10:40:41 AM

Document Has Been Signed on 04/17/2023 10:40 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, THE		FACILITY NUMBER:	157208915
ADMINISTRATOR:	RICE, DOUGLAS		FACILITY TYPE:	740
ADDRESS:	5300 HAGEMAN RD		TELEPHONE:	(661) 218-8333
CITY:	BAKERSFIELD	STATE: CA	ZIP CODE:	93308
CAPACITY:	68	CENSUS: 66	DATE:	04/14/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	02:30 PM
MET WITH:	Doug Rice, Administrator		TIME COMPLETED:	05:00 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	On 04/06/23, Licensing Program Analyst (LPA) L. Salazar arrived to the facility unannounced to conduct the required Annual Inspection Visit. 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. 07/15/2023. Facility census on this visit is 42 in Assisted Living and 24 in Memory Care. There are currently 9 residents receiving Hospice services and four 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 (87468.1 and 87468.2), Complaint Poster and facility's visitation policy. Resident Council meeting minutes were observed from the last meeting of 03/27/23. Bathrooms were toured and observed to have operational lights, running water, and non- slip floors. Hot water temperature tested at 119 degrees F. 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. (Continued on 809-C)

SUPERVISOR'S NAME: Melinda Hoffmann	TELEPHONE: (559) 341-3274
LICENSING EVALUATOR NAME: Lisa Salazar	TELEPHONE: (559) 691-0004
LICENSING EVALUATOR SIGNATURE:	DATE: 04/14/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/14/2023

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

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, THE	FACILITY NUMBER: 157208915
	VISIT DATE: 04/14/2023

NARRATIVE

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(Continued from 809)

Carbon monoxide detectors were observed to be operational. 35 Fire Extinguishers throughout the facility were observed with a service date of 04/01/23. First aid kits were observed to contain all required items.

Medications were observed to be locked in Med cart located in a staffed locked medication room. Quarterly Emergency Disaster Drill logs were observed for staff.

The following documents are requested to be updated and submitted to Fresno CCL by: 04/21/23: LIC309, Certificate of Liability Insurance.

A sample of Resident and Staff files will be reviewed at a later date on an annual continuation visit.

An exit interview was conducted with Administrator. A copy of this report was discussed and provided at the time of visit. No deficiencies cited on today's visit.

SUPERVISOR'S NAME: Melinda Hoffmann	TELEPHONE: (559) 341-3274
LICENSING EVALUATOR NAME: Lisa Salazar	TELEPHONE: (559) 691-0004
LICENSING EVALUATOR SIGNATURE:	DATE: 04/14/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 04/14/2023

LIC809 (FAS) - (06/04)

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