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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157209085
Report Date: 09/25/2024
Date Signed: 09/25/2024 11:21:28 AM

Document Has Been Signed on 09/25/2024 11:21 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:MARIGOLD PALS HOUSEFACILITY NUMBER:
157209085
ADMINISTRATOR/
DIRECTOR:		HOUCK, HELEN S.FACILITY TYPE:
735
ADDRESS:212 HAGGIN STREETTELEPHONE:
(661) 742-1088
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93309
CAPACITY: 5CENSUS: 4DATE:
09/25/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:35 AM
MET WITH:Administrative Assistant Crystianna Robinson and Administrator Helen HouckTIME VISIT/
INSPECTION COMPLETED:
11:30 AM
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Licensing Program Analyst Shawna Doucette (LPA) arrived at the facility unannounced to conduct a Required Annual inspection. LPA was met by Administrative Assistant Crystianna Robinson. LPA contacted Administrator who responded to the facility to assist with the visit.

LPA conducted a tour inside and outside of facility. Facility observed to be clean, and at a comfortable temperature. Common areas were furnished well with adequate seating and lighting available. Kitchen toured, appeared clean and safe for food preparation. Food supply checked, LPA observed an adequate supply of food. Resident rooms checked. LPA observed an adequate supply of linen. Hot water measured at 107 degrees F. Facility was set at 76 F. Exterior tour conducted, all exits open and free of obstructions. Side gate was observed to be self-latching.

Fire extinguisher serviced on 05/14/2024. Smoke detectors and carbon monoxide detectors observed operational during today’s inspection. Last fire drill conducted 7/8/2024. All cleaning supplies are locked and secured in a cabinet under the kitchen sink.

LPA reviewed staff, client records and medications.

An exit interview was conducted with the Administrator and a copy of this report was provided.

SUPERVISORS NAME: Sergiy Pidgirny
LICENSING EVALUATOR NAME: Shawna Doucette
LICENSING EVALUATOR SIGNATURE: DATE: 09/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/25/2024
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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