157209221-9-1-2022-24-AS-LSAR-CHUNNB-20220901103625

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 157209221
Report Date: 08/31/2022
Date Signed: 09/01/2022 10:36:47 AM

Document Has Been Signed on 09/01/2022 10:36 AM - 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:	BECAUSE WE CARE ASSISTED LIVING		FACILITY NUMBER:	157209221
ADMINISTRATOR:	DOBSON, LAURA		FACILITY TYPE:	740
ADDRESS:	4401 BUENA VISTA ROAD		TELEPHONE:	(661) 410-1010
CITY:	BAKERSFIELD	STATE: CA	ZIP CODE:	93311
CAPACITY:	6	CENSUS: 0	DATE:	08/31/2022
TYPE OF VISIT:	Prelicensing	UNANNOUNCED	TIME BEGAN:	03:00 PM
MET WITH:	Laura Dobson, Administrator Colleen Alvarez, RCFE Liason		TIME COMPLETED:	07:00 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	On 08/31/22, Licensing Program Analyst (LPA) L. Salazar arrived at the facility for an announced Pre-Licensing inspection. LPA was greeted by Administrator, Laura Dobson and RCFE Liason, Colleen Alvarez and allowed entry into the facility. Administrator holds Certificate #6021070740 with an expiration date of 10/23/22. COVID precautionary measures were taken at the time of entry. LPA toured the facility inside and out. LPA observed the required facility postings to include disaster plan, personal rights, discrimination notice, theft and loss policy, facility sketch identifying the emergency exits, CCLD complaint poster and Long Term Care Ombudsman poster. LPA reviewed a sample resident file and observed required licensing forms to be included. The facility has 6 single occupancy rooms located in the 300 wing of the Hoffmann Hospice Home, which is licensed by CDPH. All 6 rooms are fully furnished according to regulation and are free from odor and debris. Rooms include private bathrooms that are equipped with grab bars, covered trash bins, a supply of soap, paper towels and toilet paper. Shower is equipped with non slip adhesive. Fire clearance is approved for 6 non-ambulatory of which (6) may be bedridden. Water temperature was tested and reads at 108 degrees F. Facility emergency exits were free from obstruction. Common areas were observed to be spacious with adequate seating and lighting available. (Continued on 809-C)

SUPERVISOR'S NAME: Melinda Hoffmann	TELEPHONE: (559) 341-3274
LICENSING EVALUATOR NAME: Lisa Salazar	TELEPHONE: (559) 691-0004
LICENSING EVALUATOR SIGNATURE:	DATE: 08/31/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/31/2022

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
CCLD Regional Office, 1314 E SHAW AVE
FRESNO, CA 93710

FACILITY NAME: BECAUSE WE CARE ASSISTED LIVING	FACILITY NUMBER: 157209221
	VISIT DATE: 08/31/2022

NARRATIVE

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(continued from 809)

LPA observed a hard wired smoke detector system that signals directly to the fire department in case of emergency. Carbon monoxide detectors were also observed in all rooms to be functional. Emergency lighting is observed throughout the building and flash lights are charged and readily available.

A supply of extra linen and towels are stored inside a closet in the rooms. LPA observed a separate locked laundry service room located by the kitchen area and away from bedrooms.

Kitchen was toured and observed to be clean, stocked with food, dishes and utensils. Chemicals are stored in locked closet, inaccessible to residents. Knives and sharp items are kept locked and secure in the kitchen.

LPA observed a locked Medication room in a cental location in the facility. Medications are located in a separate locked room inside locked medication carts. Administrator reviewed medication procedures with LPA to include storage, administration and destruction procedures. All Facility staff who are administering medications are Registered Nurses (RN) and/or Licensed Vocational Nurses (LVN). A First aid kit was observed and contained all required items.

Component III was conducted during today’s pre-licensing visit that included a review of Restricted and Prohibited Health Conditions.

LPA has found the facility has met all pre licensing requirements. LPA will submit documentation to the Centralized Applications Bureau (CAB) in Sacramento for final review prior to license being issued.

SUPERVISOR'S NAME: Melinda Hoffmann	TELEPHONE: (559) 341-3274
LICENSING EVALUATOR NAME: Lisa Salazar	TELEPHONE: (559) 691-0004
LICENSING EVALUATOR SIGNATURE:	DATE: 08/31/2022

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

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/31/2022

LIC809 (FAS) - (06/04)

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