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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157209285
Report Date: 03/06/2023
Date Signed: 03/06/2023 10:04:35 AM


Document Has Been Signed on 03/06/2023 10:04 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:TEDENEK ELDER HOME 2FACILITY NUMBER:
157209285
ADMINISTRATOR:TUSAW, MYATFACILITY TYPE:
740
ADDRESS:13001 BIRKENFELD AVETELEPHONE:
(661) 205-1787
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93314
CAPACITY:6CENSUS: 0DATE:
03/06/2023
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
09:36 AM
MET WITH:Licensee, Shemeles KabtenehTIME COMPLETED:
10:13 AM
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On 03/06/2023, Licensing Program Analyst (LPA) A. Walton conducted an announced Pre-Licensing continuation inspection. LPA Walton introduced self, stated purpose of visit, and was allowed entry into the facility. LPA met with Licensee, Shemeles Kabteneh.

During the inspection on 03/01/23, LPA requested for the Licensee to bring the hot water temperature in range between 105 - 120 degrees F.

During today's visit LPA measured the hot water temperature in bathroom 1 and bathroom 2. Hot water measured between 113.9 degress F. in bathroom 1 and 113.8 degrees F. in bathroom 2.

I have found that the applicant has met all pre-licensing requirements. LPA will submit documentation to CAB in Sacramento for final review prior to license being issued.

SUPERVISOR'S NAME: Melinda HoffmannTELEPHONE: (559) 341-3274
LICENSING EVALUATOR NAME: Alexandria WaltonTELEPHONE: (559) 246-0128
LICENSING EVALUATOR SIGNATURE:
DATE: 03/06/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/06/2023
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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