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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157209320
Report Date: 05/16/2024
Date Signed: 05/16/2024 03:42:45 PM

Document Has Been Signed on 05/16/2024 03:42 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:CENTER STREET BOARD AND CAREFACILITY NUMBER:
157209320
ADMINISTRATOR/
DIRECTOR:		BARBATO, ANTHONY M.FACILITY TYPE:
735
ADDRESS:2431 CENTER STTELEPHONE:
(415) 810-0145
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93306
CAPACITY: 22CENSUS: 22DATE:
05/16/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Regional Director Steven Cruz and Licensee Anthony BarbatoTIME VISIT/
INSPECTION COMPLETED:
02:45 PM
NARRATIVE
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LPA Shawna Doucette arrived at the facility unannounced to conduct an annual inspection. LPA was granted entry by Staff Sue Devilbiss. LPA explained the purpose of the visit and met with Regional Director Steven Cruz and Licensee Anthony Barbato.

A tour of the facility was conducted with the Administrator. The facility was set at 71 F temperature and free of passageway obstructions inside and outside.

Kitchen toured, supply of food observed and food stored properly for perishable and nonperishable. Medications were stored in a locked medication cart in office/medication room. Cleaning supplies were in a locked storage closet. Smoke detectors and carbon monoxide detectors were checked and operating. Facility had a pull station fire alarm. Facility has a fire sprinkler system. Fire extinguishers were charged and had service dates of 05/13/24. LPA checked water temperature in resident bathroom which was 132.5 F.

There was outdoor seating for the residents.

Resident, medication and staff records were reviewed. While reviewing records, it was found R1 is bedridden. Facility does not have a bedridden fire clearance. R2 had a medication error missing the medication on 5/8/24. Facility staff did not have the proper annual training. Training has dates and hours with names of staff but does not state the source of where the training material was obtained. Facility does not have a menu for a modified diet for R4. Current first aid and CPR were reviewed.

Refer to 809d for deficiencies. Civil Penalties were issued for fire clearance and repeat medication error.

A copy of this report with plan of correction and appeal rights were provided to the Licensee.

SUPERVISORS NAME: Sergiy Pidgirny
LICENSING EVALUATOR NAME: Shawna Doucette
LICENSING EVALUATOR SIGNATURE: DATE: 05/16/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/16/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 4
Document Has Been Signed on 05/16/2024 03:42 PM - It Cannot Be Edited


Created By: Shawna Doucette On 05/16/2024 at 01:29 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1314 E SHAW AVE
FRESNO, CA 93710

FACILITY NAME: CENTER STREET BOARD AND CARE
FACILITY NUMBER: 157209320

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/16/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
80088(e)(1)
Fixtures, Furniture, Equipment, and Supplies
(e) Faucets used by clients for personal care such as shaving and grooming shall deliver hot water. (1) Hot water temperature controls shall be maintained to automatically regulate temperature of hot water delivered to plumbing fixtures used by clients to attain a hot water temperature of not less than 105 degrees F (40.5 degrees C) and not more than 120 degrees F (48.8 degrees C).

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above in Licensee did not meet this regulation by water temperature measuring at 132.5 F which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 05/17/2024
Plan of Correction
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Licensee agrees to submit a photo of the temperature measuring at 105 F to 120 F by POC due date 5/17/24.
Type A
Section Cited
CCR
80020(a)
Fire Clearance
(a) All facilities shall secure and maintain a fire clearance approved by the city or county fire department, the district providing fire protection services, or the State Fire Marshal.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in License does not have a license to include bedridden and per R1's LIC602 R1 is bedridden which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 05/17/2024
Plan of Correction
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Licensee agrees to reassess R1 and submit date of doctor visit and submit bedridden paperwork for clearance by POC due date 5/17/24. Licensee agrees to submit reassment of LIC 602 for R1 by 05/28/24. Civil Penalty was issued.
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:Sergiy Pidgirny
LICENSING EVALUATOR NAME:Shawna Doucette
LICENSING EVALUATOR SIGNATURE:
DATE: 05/16/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/16/2024


LIC809 (FAS) - (06/04)
Page: 2 of 4
Document Has Been Signed on 05/16/2024 03:42 PM - It Cannot Be Edited


Created By: Shawna Doucette On 05/16/2024 at 01:29 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1314 E SHAW AVE
FRESNO, CA 93710

FACILITY NAME: CENTER STREET BOARD AND CARE
FACILITY NUMBER: 157209320

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/16/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
80075(b)
Health-Related Services
(b) Clients shall be assisted as needed with self-administration of prescription and nonprescription medications.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in Licensee did not administer R2's medication as perscribed by doctor, which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 05/28/2024
Plan of Correction
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Licensee agrees to submit proof of training by 5/29/24 for all staff. Licensee agrees to submit agenda, trainer information and staff roster of staff trained by POC due date. Civil Penalty was issued.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Sergiy Pidgirny
LICENSING EVALUATOR NAME:Shawna Doucette
LICENSING EVALUATOR SIGNATURE:
DATE: 05/16/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/16/2024


LIC809 (FAS) - (06/04)
Page: 3 of 4
Document Has Been Signed on 05/16/2024 03:42 PM - It Cannot Be Edited


Created By: Shawna Doucette On 05/16/2024 at 01:29 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1314 E SHAW AVE
FRESNO, CA 93710

FACILITY NAME: CENTER STREET BOARD AND CARE
FACILITY NUMBER: 157209320

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 05/16/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
80076(a)(6)
Food Service
(a) In facilities providing meals to clients, the following shall apply: (6) Modified diets prescribed by a client's physician as a medical necessity shall be provided.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above in Licensee did not have a menu for a modified diet for R4, which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 05/28/2024
Plan of Correction
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Licensee agrees to get a menu for a modified diet that meets this regulation and meets the needs of R4 by POC due date 05/28/24.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Sergiy Pidgirny
LICENSING EVALUATOR NAME:Shawna Doucette
LICENSING EVALUATOR SIGNATURE:
DATE: 05/16/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 05/16/2024


LIC809 (FAS) - (06/04)
Page: 4 of 4