157209191-11-20-2023-24-AS-MTHO-CXRTW6-20231120140501

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 157209191
Report Date: 11/20/2023
Date Signed: 11/20/2023 02:05:10 PM

Document Has Been Signed on 11/20/2023 02:05 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
SIERRA CASCADE AC/SC, 1314 E SHAW AVE
FRESNO, CA 93710

FACILITY NAME:	WESTCHESTER HOME ON SPRUCE, THE		FACILITY NUMBER:	157209191
ADMINISTRATOR:	KAUR, LAKHWINDER		FACILITY TYPE:	740
ADDRESS:	2485 SPRUCE STREET		TELEPHONE:	(661) 633-1225
CITY:	BAKERSFIELD	STATE: CA	ZIP CODE:	93301
CAPACITY:	6	CENSUS: 4	DATE:	11/20/2023
TYPE OF VISIT:	Case Management - Annual Continuation	UNANNOUNCED	TIME BEGAN:	11:29 AM
MET WITH:	Manjit Chauhan, Licensee		TIME COMPLETED:	02:20 PM

NARRATIVE

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On 11/20/23 at 11:29 AM, Licensing Program Analyst (LPA) Malia Thao arrived unannounced to conduct an Annual inspection. LPA explained reason for inspection and was granted entry by staff. Licensees (LIC) Manjit Chauhan arrived a short time later.

LPA conducted a tour of the facility and completed the Inspection Tool.

The following deficiency was observed by LPA:
1. Med (Medication) cart was observed unlocked and accessible; and a bottle of toilet cleaner was observed accessible and stored in cabinet under bathroom sink in first hall bathroom.

Deficiency is being cited based on LPA observations in accordance with the California Code of Regulations, Title 22, see LIC809D. An immediate civil penalty is being assessed in the amount of $1000 for a repeat violation of CCR 87309(a). See LIC421IM for more details.

Exit interview conducted. A copy of this report and appeal rights were given to Licensee Manjit Chauhan, whose signature confirms receipt of this report. A Plan of Correction was reviewed and developed with Licensee.

The following updated forms are to be submitted within two weeks:

LIC610E, LIC9020, LIC500, LIC308

SUPERVISOR'S NAME: Melinda Hoffmann	TELEPHONE: (559) -341-3274
LICENSING EVALUATOR NAME: Malia Thao	TELEPHONE: 559-470-9001
LICENSING EVALUATOR SIGNATURE:	DATE: 11/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/20/2023

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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Document Has Been Signed on 11/20/2023 02:05 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SIERRA CASCADE AC/SC, 1314 E SHAW AVE
FRESNO, CA 93710

FACILITY NAME: WESTCHESTER HOME ON SPRUCE, THE	FACILITY NUMBER: 157209191
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 11/20/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Request Denied

Type A

Section Cited

CCR

87309(a)

(a) Disinfectants, cleaning solutions, poisons, firearms and other items which could pose a danger if readily available to clients shall be stored where inaccessible to clients. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, the licensee did not comply with the section cited above. LPA observed med (Medication) cart was unlocked and accessible; and a bottle of toilet cleaner was observed accessible and stored in cabinet under bathroom sink in first hall bathroom, which poses an immediate health, safety or personal rights risk to persons in care.
	POC Due Date: 11/21/2023
	Plan of Correction
1 2 3 4	Licensee will submit in-service training to all staff on the topic of cited regulation CCR 87309(a), to CCL by POC due date.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

SUPERVISOR'S NAME: Melinda Hoffmann	TELEPHONE: (559) -341-3274
LICENSING EVALUATOR NAME: Malia Thao	TELEPHONE: 559-470-9001
LICENSING EVALUATOR SIGNATURE:	DATE: 11/20/2023

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/20/2023

LIC809 (FAS) - (06/04)

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