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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157208935
Report Date: 06/30/2025
Date Signed: 06/30/2025 02:43:59 PM

Document Has Been Signed on 06/30/2025 02:43 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
FRESNO RO, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME:TRIUMPH IN THE WESTFACILITY NUMBER:
157208935
ADMINISTRATOR/
DIRECTOR:		CHAVEZ, CARLOSFACILITY TYPE:
737
ADDRESS:8130 NORRIS RDTELEPHONE:
(661) 218-9711
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93312
CAPACITY: 4CENSUS: 4DATE:
06/30/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:35 PM
MET WITH:Carlos ChavezTIME VISIT/
INSPECTION COMPLETED:
03:00 PM
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On 6/30/2025, Licensing Program Analyst (LPA) M. Medina conducted an unannounced Annual Required Inspection. LPA met with Administrator, Carlos Chavez to conduct facility tour.

Currently, there are four (4) residents in placement. All residents were present at time of facility inspection. Residents were observed to be working along side staff doing house chores at start of facility tour.

Facility observed to be clean, odor free, and a comfortable temperature. Facility tour began, in laundry area near kitchen. LPA observed all chemicals to be locked, secured, and inaccessible to residents. Kitchen toured, LPA observed facility to have a 2-day supply of perishable food and a 7-day supply of non-perishable food available. Facility has knives locked in safe that is placed in locked kitchen cabinet. Menus are posted for each individual to meet dietary needs. All common areas of the facility observed to have adequate seating for all residents in care. Resident bedrooms toured, all resident rooms observed to have required accommodations. Resident bathrooms toured, all fixtures observed to be operational during time of inspection. Water temperature measured at 112 degrees F in the resident bathroom. First Aid kit present and secured in closet with resident toiletries

Outside of facility tour, all exits open free of obstruction. Pool is surrounded by a wrought iron fence that is locked and secured. Side gate near swimming pool area is equipped with delayed egress and observed operational. Facility has large covered patio area with seating for all residents.

Facility observed to have a pull station near front door and is equipped with sprinkler system. Smoke detectors and carbon monoxide detectors present and observed operational during today's inspection. Fire extinguisher present with a date of service 11/06/24. Last fire drill conducted on 6/12/25 and last disaster drill conducted on 6/13/25 according to facility records.

Due to time constraints LPA will return to conduct review of resident and staff files and complete inspection tool.

No deficiencies cited during inspection. Exit interview conducted and a copy of report provided for facility records.
NAME OF LICENSING PROGRAM MANAGER: Sergiy Pidgirny
NAME OF LICENSING PROGRAM ANALYST: Melinda Medina
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 06/30/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/30/2025
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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