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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157209503
Report Date: 11/12/2024
Date Signed: 11/12/2024 12:14:23 PM

Document Has Been Signed on 11/12/2024 12:14 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:CARING HAVEN ASSISTED LIVING LLCFACILITY NUMBER:
157209503
ADMINISTRATOR/
DIRECTOR:		QUIROZ, JANIE VALERIEFACILITY TYPE:
740
ADDRESS:4613 CHERRYROCK AVETELEPHONE:
(661) 472-7288
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93313
CAPACITY: 6CENSUS: 0DATE:
11/12/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:41 AM
MET WITH:Licensee/Administrator Janie QuirozTIME VISIT/
INSPECTION COMPLETED:
10:30 AM
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Licensing Program Analyst (LPA) Shawna Doucette arrived to the facility announced to conduct the Pre licensing visit. LPA Shawna Doucette met with Licensee/Administrator Janie Quiroz who granted LPA's entry into the facility.

LPA toured the facility. Facility is clean. Facility smoke detectors/carbon monoxide were operating during visit. Facility has a pull station fire alarm. Fire extinguisher last serviced 11/11/24. Facility has four resident bedrooms. Resident rooms had proper furnishings. LPA observed the internet box with cords on the floor in a resident bedroom that could pose as a tripping hazard. Resident bathroom water temperature measured at 130 F. Facility has grooming products for residents.

Facility has a locked medication cart to store medications. Cleaning supplies were locked under kitchen sink. Facility has a plan to lock knives in a lock box but currently does not have the lock box at the facility.

Facility has a spa. Facility has a way to lock the spa however padlock was not on spa during visit. Facility does not have outdoor seating for residents.

Facility has a plan for activities for residents. Facility phone number is (661) - 472-0885. All postings were posted.

Component III was conducted with the Licensee/Administrator.

A copy of this report was provided.
SUPERVISORS NAME: Sergiy Pidgirny
LICENSING EVALUATOR NAME: Shawna Doucette
LICENSING EVALUATOR SIGNATURE: DATE: 11/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/12/2024
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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