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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157208935
Report Date: 09/18/2023
Date Signed: 09/18/2023 12:23:18 PM

Document Has Been Signed on 09/18/2023 12:23 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:CHAVEZ, CARLOSFACILITY TYPE:
737
ADDRESS:8130 NORRIS RDTELEPHONE:
(661) 218-9711
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93312
CAPACITY: 4CENSUS: 4DATE:
09/18/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:22 AM
MET WITH:Carlos Chavez Jr, Jill BivinsTIME COMPLETED:
12:38 PM
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On 9/18/23, Licensing Program Analyst (LPA) M. Medina conducted an unannounced Annual Required inspection. LPA introduced self, stated purpose of visit and allowed entrance by Carlos Chavez Jr., Administrator. Jill Bivins, Program Liaison & Assurance Development Coordinator arrived a short time later to conduct facility inspection.

Facility tour conducted with Administrator. Three residents present during today's inspection, residents attend in house day program. Residents observed to be having breakfast, in their bedroom, or interacting with staff. Facility observed to be clean and odor free, well lit, and have adequate seating throughout facility for all residents. Resident bedrooms toured and observed to have required furnishings available. Kitchen toured, facility has a 2-day supply of perishable and a 7-day supply of non-perishable food available. All knives are locked in a safe and secured in a locked cabinet. All stove knobs have been removed for safety of residents. Resident bathrooms toured, and observed to be in good repair. Hot water measured at 114 degrees F during facility inspection.

Fire Extinguisher present with a service date of 11/21/22. Carbon monoxide and smoke detectors tested and observed operational during today's inspection. Facility records indicate the last fire drill was conducted on 9/13/2023.

Outside of facility toured. Secured perimeter with delayed egress observed. Pool is locked and secured and inaccessible to residents. No hazards observed.

No deficiencies observed during facility inspection.
SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Melinda Medina
LICENSING EVALUATOR SIGNATURE: DATE: 09/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/18/2023
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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