<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157208933
Report Date: 10/21/2024
Date Signed: 10/21/2024 12:17:33 PM

Document Has Been Signed on 10/21/2024 12:17 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:NEMIA HOMEFACILITY NUMBER:
157208933
ADMINISTRATOR/
DIRECTOR:		GO, CELESTEFACILITY TYPE:
734
ADDRESS:3256 JENKINS RDTELEPHONE:
(650) 238-4987
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93314
CAPACITY: 5CENSUS: 5DATE:
10/21/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:29 AM
MET WITH:Administrator, Celeste GoTIME VISIT/
INSPECTION COMPLETED:
12:32 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 10/21/2024, Licensing Program Analyst (LPA) Walton arrived unannounced to conduct an annual inspection. LPA introduced self, stated the purpose of the visit, and requested to meet with the Administrator. LPA was granted entry to the facility by facility staff. LPA met with Administrator, Celeste Go.

LPA reviewed facility records. LPA observed a separate, complete, and current record for clients in care. Personnel records were reviewed and found to be complete and current, including up to date First-Aid certification. LPA reviewed the facility's disaster and mass casualty plan. Last fire/disaster drill was conducted on 10/01/2024 per facility records.

LPA conducted a tour of the facility with Administrator. Facility appeared clean, odor free, and at a comfortable temperature. Common areas were furnished with adequate lighting. Client bedrooms toured. LPA observed bedrooms to have required furnishings and adequate lighting. Bathrooms toured and observed to be operational. Hot water measured at 109.1 degrees F. Facility kitchen toured and observed safe for food preparation. LPA observed an adequate food supply. Fire extinguishers were observed and were last serviced on 03/16/2024. Smoke detector and carbon monoxide detector observed to operational during today's visit.

Exterior tour conducted. All passageways were open and free from obstructions. All cleaning supplies were locked in the garage, and inaccessible to clients in care.

Medications are kept locked and inaccessible to clients in care in the medication cart. Medications reviewed and found to be administered as prescribed.

No deficiencies issued. Exit interview conducted. A copy of this report was discussed and provided to Administrator, Celeste Go, whose signature on this form confirms receipt of this document.

LPA is requesting the following documents be submitted to the Fresno CCL office by 11/04/2024: Current copy of Administrator Certificate, Designation of Facility Responsibility (LIC308), Administrator Organization (LIC 309), Affidavit regarding Client/Resident Cash Resources (LIC 400),Emergency and Disaster Plan (LIC610D), Personnel Report (LIC500), Register of Facility Clients/Residents for (LIC9020), Surety Bond.

SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Alexandria Walton
LICENSING EVALUATOR SIGNATURE: DATE: 10/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/21/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1