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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157209285
Report Date: 01/24/2024
Date Signed: 01/24/2024 12:24:10 PM


Document Has Been Signed on 01/24/2024 12:24 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:TEDENEK ELDER HOME 2FACILITY NUMBER:
157209285
ADMINISTRATOR:KABTENEH, SHEMELESFACILITY TYPE:
740
ADDRESS:13001 BIRKENFELD AVETELEPHONE:
(661) 205-1787
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93314
CAPACITY:6CENSUS: 2DATE:
01/24/2024
TYPE OF VISIT:Post LicensingUNANNOUNCEDTIME BEGAN:
10:35 AM
MET WITH:Facility Staff, Azeb BiratuTIME COMPLETED:
12:38 PM
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On 01/24/2024, Licensing Program Analyst (LPA) Walton arrived unannounced to conduct an annual inspection. LPA introduced self, stated the purpose of the visit and requested to meet with the Administrator. Facility staff contacted Administrator, Shemeles Kabteneh via telephone. Administrator is unable to attend this inspection. LPA received verbal permission to meet with Facility Staff, Azeb Biratu.

LPA conducted a tour inside and outside the facility, and reviewed facility records. LPA observed the following:

Facility currently has 2 residents. Facility observed to be clean, odor free, and at a comfortable temperature. The dining room and living room were furnished well with adequate seating and lighting. Resident rooms appeared clean and had all required furnishings. LPA observed an adequate supply of linen. Resident bathrooms were properly equipped with securely fastened grab bars and non-skid mats. Hot water measured at 115.6 degrees F. Kitchen toured, appeared clean, observed a 7-day supply of non-perishable and 2-day supply of perishable food. Knives/Sharps observed to be locked in a kitchen drawer. Exterior tour conducted, all exits open and free of obstructions. Side gate was observed to be self-latching.

Fire extinguisher serviced on 04/03/23. Smoke detectors and carbon monoxide detectors observed operational during today’s inspection. All chemicals observed to be locked and secure in a cabinet in the laundry room. Medications observed to be inaccessible to persons in care and administered as prescribed.

No deficiencies issued during today's inspection. Exit interview conducted. A copy of this report was discussed and provided to Facility Staff, Azeb Biratu, whose signature on this form confirms receipt of this document.

SUPERVISOR'S NAME: Melinda HoffmannTELEPHONE: (559) 341-3274
LICENSING EVALUATOR NAME: Alexandria WaltonTELEPHONE: (559) 246-0128
LICENSING EVALUATOR SIGNATURE:
DATE: 01/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/24/2024
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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