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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157209146
Report Date: 06/14/2021
Date Signed: 06/14/2021 12:40:30 PM

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:QUALITY CARE ASSISTED LIVINGFACILITY NUMBER:
157209146
ADMINISTRATOR:ESPINAL, ALMAFACILITY TYPE:
740
ADDRESS:2607 MT. VERNON AVENUETELEPHONE:
(661) 871-8133
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93306
CAPACITY:54CENSUS: 37DATE:
06/14/2021
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
09:10 AM
MET WITH:Administrator Alma Espinal and Licensee, Kristine JuarezTIME COMPLETED:
12:29 PM
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Licensing Program Analyst (LPA) Darius Williams conducted an announced Prelicensing visit. LPA Williams met with Licensee Kristine Juarez and Administrator Alma Espinal, and discussed the purpose of the visit.

LPA Williams began the tour at the entrance of the facility and toured the inside and outside of the facility.

Facility was observed at a comfortable temperature, clean, in good repair, and no passageway obstructions or fire hazards were observed inside or outside. Common areas furnished and well-lit throughout. Social distancing is maintained. LPA Williams observed the kitchen to be absent of any trash or debris. A two day supply of perishable and seven day supply of non-perishable food were observed.

Medications and chemicals were kept locked in separate cabinets. Residents bedrooms were observed to furnished with bed, dresser, night stand, and overhead lightning. Mattresses, box springs, sheets, and linens, were absent of any tears and stains.

Bathrooms were equipped with non-skid mats and securely fastened grab bars. Towels, linens, and personal hygiene supplies were observed in storage. There are no bodies of water outside.

All Fire extinguishers are current; maintenance dates of October 2020 and April 2021. Carbon monoxide and smoke detectors were tested and observed to be operational. First Aid Kit was checked and observed to have the required supplies. Emergency exit plan, phone numbers, and required postings were observed. A working telephone was present.

Component III was reviewed with Licensee and Administrator. LPA will submit report to Centralized Application Buruea for review, pending issuing of license.
SUPERVISOR'S NAME: Serigy PidgirnyTELEPHONE: (559) 246-0610
LICENSING EVALUATOR NAME: Darius WilliamsTELEPHONE: 559-243-8080
LICENSING EVALUATOR SIGNATURE:

DATE: 06/14/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/14/2021
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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