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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157209249
Report Date: 10/18/2023
Date Signed: 10/18/2023 12:40:05 PM


Document Has Been Signed on 10/18/2023 12:40 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:DELIAN'S MANOR SENIOR CARE LLCFACILITY NUMBER:
157209249
ADMINISTRATOR:DELA CRUZ, DENNISFACILITY TYPE:
740
ADDRESS:10725 RISING SUN DRIVETELEPHONE:
(661) 703-3543
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93312
CAPACITY:6CENSUS: 5DATE:
10/18/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:38 AM
MET WITH:Dennis Dela CruzTIME COMPLETED:
12:54 PM
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On 10/18/23, Licensing Program Analyst (LPA) M. Medina arrived at the facility unannounced to conduct an Annual Required visit. LPA introduced self, stated purpose of visit and allowed entrance by Direct Care Staff, Licensee/Administrator Dennis Dela Cruz contacted by telephone and arrived a short time later to conduct inspection.

Facility tour began with the resident bedrooms. Resident bedrooms are adequately furnished and have sufficient lighting. Resident bathrooms toured. Resident bathrooms have grab bars in all toilet and tub/shower areas. Non-skid mats are present. Water temperature measured at 117 degrees F in hallway bathroom.

Dining and living rooms are sufficiently furnished and have adequate lighting. Kitchen toured. Pantry & refrigerator/freezers contain 7 day supply of non-perishable & 2 day supply of perishable food. LPA observed food to be properly stored and dated in both refrigerator and freezer. Medications observed to be locked and stored in a cabinet in the kitchen. First aid kit observed with all required items. Smoke detectors and carbon monoxide detector observed to be operational during visit.

Outside of the facility was toured. All fire exits open freely and are free of obstruction. No outside hazards observed.

No deficiencies cited during today's visit.
SUPERVISOR'S NAME: Melinda HoffmannTELEPHONE: (559) 341-3247
LICENSING EVALUATOR NAME: Melinda MedinaTELEPHONE: (559) 410-5914
LICENSING EVALUATOR SIGNATURE:
DATE: 10/18/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/18/2023
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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