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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157201087
Report Date: 09/14/2024
Date Signed: 09/14/2024 10:40:16 AM

Document Has Been Signed on 09/14/2024 10:40 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:MERCIE'S HOME #5FACILITY NUMBER:
157201087
ADMINISTRATOR/
DIRECTOR:		TAUCHEN, ADAMFACILITY TYPE:
740
ADDRESS:812 SESNON STREETTELEPHONE:
(661) 323-0462
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93309
CAPACITY: 6CENSUS: 4DATE:
09/14/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:15 AM
MET WITH:Supervisor Gerald DeclaroTIME VISIT/
INSPECTION COMPLETED:
10:30 AM
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Licensing Program Analyst (LPA) Shawna Doucette arrived at the facility unannounced to conduct an Annual Inspection. LPA was granted entry by Supervisor Gerald Declaro. LPA contacted Administrator Adam Tauchen via telephone who gave permission for Staff to assist with the visit and sign this report.

LPA conducted a tour inside and outside of facility. Facility observed to be clean, and at a comfortable
temperature. Common areas were furnished well with adequate seating and lighting available. Kitchen toured, and was clean and safe for food preparation. Food supply checked, LPA observed an adequate supply of food. Resident rooms checked. LPA observed an adequate supply of linen. Hot water measured at 109.8 degrees F.

Facility was set at 73 F. Exterior tour conducted, all exits open and free of obstructions. Side gate was
observed to be self-latching. Facility has a pool that is gated, locked and inaccessible to residents in care.

Fire extinguisher serviced on 10/3/2023. Smoke detectors and carbon monoxide detectors observed
operational during today’s inspection. Facility has a pull station fire alarm. Last fire drill conducted 09/01/2024. All cleaning supplies are locked in a cabinet in the garage.

Staff records, resident records and medications were checked.


An exit interview was conducted and a copy of this report was provided.
SUPERVISORS NAME: Sergiy Pidgirny
LICENSING EVALUATOR NAME: Shawna Doucette
LICENSING EVALUATOR SIGNATURE: DATE: 09/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/14/2024
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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