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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157209175
Report Date: 08/23/2021
Date Signed: 08/23/2021 03:45:41 PM

Document Has Been Signed on 08/23/2021 03:45 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:HERITAGE LIVING IIIFACILITY NUMBER:
157209175
ADMINISTRATOR:GREWAL, SHARNPREETFACILITY TYPE:
735
ADDRESS:3900 DOS LAGOS DRIVETELEPHONE:
(661) 979-0417
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93311
CAPACITY: 6CENSUS: 0DATE:
08/23/2021
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
03:45 PM
MET WITH:Tina Malhi, LicenseeTIME COMPLETED:
04:30 PM
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On 08/23/2021, Licensing Program Analyst (LPA) L. Salazar arrived at the facility to conduct the pre-licensing inspection. LPA met with licensee Tina Malhi, administrator Sharnpreet "Preet" and house manager, Loree Malhi Facility type is Adult Residential Facility (ARF).

LPA conducted a tour inside and outside the facility. Facility temperature was 74 degrees. LPAs observed the back yard with secure fence and gates. LPAs observed all hallways and passageways to be free of clutter or hazards and including night-lights. LPA observed bedrooms and living areas to be furnished per regulation. LPA observed an extra supply of linens and first aid kit. Bathrooms observed to be functioning properly and have non-skid mats. Cleaning supplies and chemicals are stored in a locked cabinet in the laundry room. Medications will be stored in a locked cabinet.

LPA observed fully charged fire extinguisher with purchase date of 5/22/21 in the kitchen Smoke alarms and carbon monoxide detectors were observed, tested and operational.

Fire clearance is granted for 6 (six) non-ambulatory residents per Kern County Fire Department.

Facility landline is 661-735-5211

Conducted component III orientation.
SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Lisa Salazar
LICENSING EVALUATOR SIGNATURE: DATE: 08/23/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/23/2021
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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