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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157209064
Report Date: 12/10/2021
Date Signed: 12/13/2021 09:19:32 AM

Document Has Been Signed on 12/13/2021 09:19 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:RICHARDS RANCH LIVINGFACILITY NUMBER:
157209064
ADMINISTRATOR:RICHARD, LESLIEFACILITY TYPE:
735
ADDRESS:16732 PALM AVETELEPHONE:
(661) 587-4565
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93314
CAPACITY: 6CENSUS: 0DATE:
12/10/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:17 PM
MET WITH:Administrator Leslie RichardTIME COMPLETED:
01:15 PM
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Licensing Program Analyst LPA Shawna Doucette conducted an Annual Inspection on this date. LPA was met by Administrator Leslie Richard and discussed the purpose of the visit. LPA and Administrator Leslie Richard began the tour at the front entrance/office of the facility.

Facility has one entrance/exit point. Visitor log-in/temperature check, masks, and disinfection station was observed upon entry. Facility does not currently have clients in care or staff. Facility was recently licensed. Facility will submit photos of Covid signs/Handwashing signs throughout the facility. Facility has a mitigation plan however will need to submit mitigation plan on LIC808.

Cleaning supplies were observed behind a locked in a cabinet.

No deficiencies were observed.

Exit interview was conducted and a copy of this report was provided via email
SUPERVISORS NAME: Sergiy Pidgirny
LICENSING EVALUATOR NAME: Shawna Doucette
LICENSING EVALUATOR SIGNATURE: DATE: 12/10/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/10/2021
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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