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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157209152
Report Date: 11/22/2021
Date Signed: 11/22/2021 05:58:42 PM

Document Has Been Signed on 11/22/2021 05:58 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
CCLD Regional Office, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME:CHARTER WEST HOMECARE, LLCFACILITY NUMBER:
157209152
ADMINISTRATOR:CLEMENTE, LOUIEFACILITY TYPE:
735
ADDRESS:6104 COCHRAN DRIVETELEPHONE:
(661) 588-7813
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93309
CAPACITY: 4CENSUS: 4DATE:
11/22/2021
TYPE OF VISIT:PrelicensingANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Robert Clemente, Licensee
Luis Clemente, Licensee		TIME COMPLETED:
10:30 AM
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On 11/22/21 at 8:30 AM, Licensing Program Analyst (LPA) Malia Thao arrived announced to conduct a Pre-Licensing inspection. LPA met with Licensees Robert Clemente and Luis Clemente and was granted entry.

LPA toured inside and outside of facility. No obstructions observed. All bedrooms have sufficient furniture and lighting. Hot water measured 115 degrees F. Facility set at comfortable temperature. Fire extinguisher was last serviced 3/31/2021. Smoke and carbon monoxide combination detector tested and operational. Dishware and utensils observed. Centrally stored medication observed in locked kitchen cabinet. Chemicals observed in locked cabinet under kitchen sink and in locked garage cabinet. First aid kit observed complete. 2-day perishables and 7-day non-perishables observed.

Landline telephone for facility is (661) 859-0510. All pre-licensing requirements have been met. LPA will notify CAB in Sacramento for final review prior to license being issued.

Exit interview conducted. A copy of this report was emailed to Licensees with Read receipt to confirm receipt of this report.
SUPERVISORS NAME: Andy Xiong
LICENSING EVALUATOR NAME: Malia Thao
LICENSING EVALUATOR SIGNATURE: DATE: 11/22/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/22/2021
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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