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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157208926
Report Date: 08/27/2021
Date Signed: 08/27/2021 11:39:31 AM

Document Has Been Signed on 08/27/2021 11:39 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:REDWOODFACILITY NUMBER:
157208926
ADMINISTRATOR:CRANDELL, DINAFAYFACILITY TYPE:
735
ADDRESS:14618 REDWOOD PASSTELEPHONE:
(661) 396-0465
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93314
CAPACITY: 4CENSUS: 2DATE:
08/27/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Administrator Dinafay CrandellTIME COMPLETED:
11:00 AM
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Licensing Program Analyst LPA Shawna Doucette conducted an Annual Inspection on this date. LPA called Administrator Dinafay Crandell and advised the Administrator that LPA was at the facility to do an Infection Inspection at the facility. Administrator Dinafay Crandell responded to the facility to conduct the visit with LPA and began the tour at the front entrance of the facility.

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 behind a locked door in the master bedroom and laundry room. LPA observed the following personal protective equipment in a storage cabinet in garage; hand sanitizer, face shield, gloves, gowns and masks. Resident’s files have updated emergency contact information. Covid 19 training was observed for staff.

Facility was provided with 2 packages of gowns and 1 box of N95 masks.

No deficiencies were observed.

Exit interview was conducted and a copy of this report was provided via email.
SUPERVISORS NAME: Sergiy Pidgirny
LICENSING EVALUATOR NAME: Shawna Doucette
LICENSING EVALUATOR SIGNATURE: DATE: 08/27/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/27/2021
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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