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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157208935
Report Date: 08/01/2022
Date Signed: 08/01/2022 02:26:40 PM

Document Has Been Signed on 08/01/2022 02:26 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:TRIUMPH IN THE WESTFACILITY NUMBER:
157208935
ADMINISTRATOR:MARTINEZ,DEANFACILITY TYPE:
737
ADDRESS:8130 NORRIS RDTELEPHONE:
(661) 589-9992
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93312
CAPACITY: 4CENSUS: 4DATE:
08/01/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:45 PM
MET WITH:Agustin Aguilera
Jill Bivins		TIME COMPLETED:
02:45 PM
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On 8/1/22, Licensing Program Analyst (LPA) M. Medina conducted an unannounced Annual Required Infection Control Inspection. LPA introduced self and allowed entrance by Agustin Aguilera, Lead Staff Tier II. All COVID protocols are in place, sign in roster, temperature check, hand sanitizer available throughout facility. Dean Martinez, Administrator Certificate #6057136735, expires 11/4/2023.

Facility tour conducted with Agustin Aguilera and Jill Bivins, Program Liaison & Assurance Coordinator. Residents observed to be having lunch or relaxing in their bedroom during inspection. Development Coordinator. LPA observed 4 residents present and 7 staff working. All common areas have sufficient lighting and seating for residents in care. Kitchen toured, menu observed to be posted. Facility has a 2-day supply of perishable and 7-day supply of non-perishable available. All sharps are locked and secured in kitchen cabinet. Resident bedrooms are all private. Resident bathrooms toured, LPA observed paper towels and hand soap available. Chemicals are locked and secured in the garage. Medication is locked and secured in medication cart in staff office. All resident's have a 30-day supply of medication. Fire extinguisher present with a date of service of 12/07/2021. Last fire drill conducted 7/15/22.

Outside of facility toured. Pool area is surrounded by locked perimeter fence and not accessible to residents.

No deficiencies cited during today's inspection.

Exit interview conducted. A copy of this report provided for facility records.
SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Melinda Medina
LICENSING EVALUATOR SIGNATURE: DATE: 08/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/01/2022
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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