157209136-6-13-2024-24-AS-LPAT-D67S4L-20240613133256

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 157209136
Report Date: 06/13/2024
Date Signed: 06/13/2024 01:33:03 PM

Document Has Been Signed on 06/13/2024 01:33 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:	REDWOOD SENIOR LIVING BAKERSFIELD		FACILITY NUMBER:	157209136
ADMINISTRATOR:	PONCE, BEATRIZ		FACILITY TYPE:	740
ADDRESS:	810 S UNION AVE		TELEPHONE:	(415) 810-0145
CITY:	BAKERSFIELD	STATE: CA	ZIP CODE:	93307
CAPACITY:	41	CENSUS: 41	DATE:	06/13/2024
TYPE OF VISIT:	Case Management - Annual Continuation	UNANNOUNCED	TIME BEGAN:	08:38 AM
MET WITH:	Beatriz Ponce, Administrator		TIME COMPLETED:	01:45 PM

NARRATIVE
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25	Licensing Program Analyst L. Padgett (LPA), conducted an unannounced annual continuation visit (visit started on 5/31/2024) to the facility and met with Administrator Beatriz Ponce (AD) and Regional Director Steven Cruz. LPA stated the purpose of the visit and was accompanied by AD while conducting the inspection of the facility. At the time of the visit, LPA observed residents in the facility. LPA observed that the kitchen was well maintained, with working lights and well maintained appliances. The knives were kept in a locked drawer not easily accessible. The kitchen counters and sink are free from debris. LPA observed a trash bin with the lid. LPA observed that refrigerator, was kept at a 42 degree F, well maintained and clean. LPA observed a 2 day perishable food supply. The kitchen pantry was clean, organized and had 7 days of non-perishable food. No expired food was observed. LPA observed the dining room with 4 tables is well lit. Dining has seating for 16 and is clean and in good condition. LPA observed the living room has no fireplace. Television was observed to be in a secure place, the living room floor has carpet in good condition. LPA observed sofas and recliners to be in good condition. In the hallway that leads to the bedrooms, LPA observed, smoke detector and carbon monoxide detectors installed. The smoke alarm and carbon monoxide detectors were tested by AD and are functioning Fire extinguishers are mounted on the walls and inspected on 5/1/2024 with the pressure gauge in good range as indicated on the meter. continued on the LIC809-C

SUPERVISOR'S NAME: Sergiy Pidgirny	TELEPHONE: (559) 246-0610
LICENSING EVALUATOR NAME: Lissett Padgett	TELEPHONE: (559) 243-8080
LICENSING EVALUATOR SIGNATURE:	DATE: 06/13/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2024

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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
FRESNO RO, 1314 E SHAW AVE
FRESNO, CA 93710

FACILITY NAME: REDWOOD SENIOR LIVING BAKERSFIELD	FACILITY NUMBER: 157209136
	VISIT DATE: 06/13/2024

NARRATIVE

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LPA observed 7 resident bedrooms. The bedrooms well lit. Window and screens are in good condition. Bedrooms have two twin beds, ample space between the beds, a shared dresser, two night stands, a shared closet that can store the residents' personal belongings. Furniture and linens are free from stain and are well maintained.

LPA with AD inspected the backyard. LPA, observed that the backyard is well maintained, trees and grass in good condition. Patio furniture is clean and ready for use. LPA observed two locked sheds. Sheds store extra equipment, incontinence pads/diapers, emergency supply of water (4 five gallon water jugs). The exterior walkways are free from obstructions and debris.

LPA observed Staff Room to be clean and organized.

LPA observed medications are stored in medication room. Medication bins for each resident, labeled and organized. First aid kit was inspected and found to contain the required items.

LPA reviewed residents and staff records with AD and found that training documents are in not up to date.

Deficiencies were cited during today's visit per California Code of Regulations (CCR) Title 22. An exit interview was conducted with AD. A copy of the signed report and appeals rights were provided.

LPA is requesting the following documents be submitted to the Fresno CCL office by 6/21/2024, Designation of Facility Responsibility (LIC308), Administrator Organization (LIC 309), Affidavit regarding Client/Resident Cash Resources (LIC 400), Liability Insurance, Emergency and Disaster Plan (LIC 610D) Personnel Report (LIC500), Register of Facility Clients/Residents for (LIC9020A), Surety Bond.

SUPERVISOR'S NAME: Sergiy Pidgirny	TELEPHONE: (559) 246-0610
LICENSING EVALUATOR NAME: Lissett Padgett	TELEPHONE: (559) 243-8080
LICENSING EVALUATOR SIGNATURE:	DATE: 06/13/2024

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/13/2024

LIC809 (FAS) - (06/04)

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