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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157209493
Report Date: 11/05/2024
Date Signed: 11/06/2024 08:49:01 AM

Document Has Been Signed on 11/06/2024 08:49 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:SERENITY SPRINGS HOME CAREFACILITY NUMBER:
157209493
ADMINISTRATOR/
DIRECTOR:		TELMO, DIO VFACILITY TYPE:
740
ADDRESS:10813 DELICATO CTTELEPHONE:
(661) 246-8702
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93312
CAPACITY: 6CENSUS: 6DATE:
11/05/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:45 AM
MET WITH:Dio V Telmo
Socorro Ann Telmo		TIME VISIT/
INSPECTION COMPLETED:
01:28 PM
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On 11/05/2024, Licensing Program Analyst (LPA) M. Medina arrived unannounced to conduct a Pre-Licensing inspection. LPA introduced self, stated the purpose of the visit, and was granted entry to the facility. LPA met with Administrator Dio V Telmo and Socorro Ann Telmo.

The facility is being licensed as a change of ownership. The facility is a 5 bedroom, 2 1/2 bathroom home. Fire clearance has been approved for six (6) non-Ambulatory. There are currently 6 residents in placement.

LPA conducted a tour of the facility and observed the following. Facility appeared clean and at a comfortable temperature. Common areas were furnished with adequate lighting. Resident bedrooms were toured and observed to have the required furnishings. Bathrooms toured and observed to be operational. Hot water measured at 112.9 degrees F. Kitchen toured and observed to be safe for food preparation. LPA observed an adequate food supply.

First-Aid kit observed and contained all required items. Smoke detector and carbon monoxide detector observed to be operational during today's inspection. A fire extinguisher was observed to be last serviced on 04/01/2024.

Exterior tour conducted. All exits were open and free from obstructions. LPA observed the facility yard to be sufficient in size and appropriately equipped for outdoor use. There is seating and shade umbrella for resident seating. Pool is surrounded by a perimeter fence which was observed to be locked, secured, and inaccessible to residents.

Component III conducted.

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. Exit interview conducted. A copy of this report will provided via email to Administrator, Dio V Telmo.
SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Melinda Medina
LICENSING EVALUATOR SIGNATURE: DATE: 11/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/05/2024
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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