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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157208969
Report Date: 08/04/2022
Date Signed: 08/04/2022 11:38:47 AM

Document Has Been Signed on 08/04/2022 11:38 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:PATTI ROSE HOMEFACILITY NUMBER:
157208969
ADMINISTRATOR:HARDGE, TAMERRA AFACILITY TYPE:
735
ADDRESS:3150 PATTI ROSE AVENUETELEPHONE:
(818) 720-9667
CITY:ROSAMONDSTATE: CAZIP CODE:
93560
CAPACITY: 4CENSUS: 0DATE:
08/04/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:15 AM
MET WITH:Administrator Terrence HardgeTIME COMPLETED:
12:00 PM
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On 8/4/22, Licensing Program Analyst (LPA) M. Yang arrived unannounced to conduct an Annual Inspection - Infection Control. LPA introduced self, stated the purpose of the visit, and met with Administrator Terrence Hardge. LPA conducted facility tour with Administrator. There are currently no residents or staff at the facility.

Upon entry facility staffs was observed with facial mask. Visitor log-in/temperature check was observed upon entry. Hand sanitizer was readily available to clients and visitors. observed social distancing and cough etiquette postings in facility. LPA observed 30 days PPE supplies.

All entrances and exit were clear from obstructions.

All clients’ room toured and observed to be adequately furnished and lit. LPA observed four vacant bedrooms that are single occupant. All bathrooms observed trash bin with lid.

No deficiencies issued during this inspection. Exit interview was conducted.

An exit interview conducted. Administrator was provided copy of report.

SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Mai Yang
LICENSING EVALUATOR SIGNATURE: DATE: 08/04/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/04/2022
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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