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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157208954
Report Date: 11/21/2024
Date Signed: 11/21/2024 11:49:54 AM

Document Has Been Signed on 11/21/2024 11:49 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:DEAN'S CARE VILLA 111FACILITY NUMBER:
157208954
ADMINISTRATOR/
DIRECTOR:		NOBLEZA, BASILISAFACILITY TYPE:
740
ADDRESS:13111 HINAULT DRIVETELEPHONE:
(661) 368-2489
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93314
CAPACITY: 6TOTAL ENROLLED CHILDREN: 0CENSUS: 6DATE:
11/21/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:27 AM
MET WITH:Administrator, John NoblezaTIME VISIT/
INSPECTION COMPLETED:
11:58 AM
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On 11/21/2024, Licensing Program Analyst (LPA) Walton arrived unannounced to conduct an annual inspection. LPA introduced self, stated the purpose of the visit, and was granted entry to the facility. Administrator was present in the facility, LPA met with Administrator, John Nobleza.

LPA reviewed facility records and observed the following: Resident records were found to be current and complete. Staff records were found to be current and complete. Staff training observed to be up to date. Emergency disaster plan was reviewed. Per Administrator, last fire drill was conducted on 09/25/2024. Medications were reviewed. Medications were observed to be administered as prescribed.

LPA conducted a facility tour with Administrator. Common areas were equipped with adequate furnishings and lighting. Smoke detectors and carbon monoxide detector observed to be operational during today's inspection. Kitchen toured. LPA observed the kitchen to be clean and safe for food preparation. LPA observed a 7-day supply of non-perishable foods and a 2-day supply of perishable foods. Residents bedrooms toured and observed to have required furnishings. LPA observed an adequate supply of linens. Bathrooms were toured and observed to be operational. Hot water measured at 120 degrees F during today's visit. LPA advised for Administrator to monitor the water temperature to ensure water temperature remains in compliance with Title 22 regulations. Fire extinguisher was last serviced on 07/26/2024.

Exterior tour conducted. All exits were open and free from obstructions during today's inspection. No fire clearance issues observed.

No deficiencies issued. Exit interview conducted. A copy of this report was discussed and provided to Administrator, John Nobleza, via email due to technical issues. Administrator was informed that a hard copy will be mailed to the facility. Report was signed on-site by a facility representative.

LPA is requesting the following documents be submitted to the Fresno CCL office by 12/05/2024: Current copy of Administrator Certificate, Designation of Facility Responsibility (LIC308), Administrator Organization (LIC 309), Affidavit regarding Client/Resident Cash Resources (LIC 400), Liability Insurance, Emergency and Disaster Plan (LIC 610E) Personnel Report (LIC500), Register of Facility Clients/Residents for (LIC9020A), Surety Bond*
Melinda HoffmannTELEPHONE: (559) 341-3274
Alexandria WaltonTELEPHONE: (559) 246-0128
DATE: 11/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/21/2024
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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