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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157202423
Report Date: 01/26/2023
Date Signed: 01/26/2023 10:17:51 AM

Document Has Been Signed on 01/26/2023 10:17 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:SPRING HOMEFACILITY NUMBER:
157202423
ADMINISTRATOR:NEBRIDA, OFELIA CUDALFACILITY TYPE:
740
ADDRESS:8722 HOODSPORT AVETELEPHONE:
(661) 587-6177
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93312
CAPACITY: 5CENSUS: 5DATE:
01/26/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
07:56 AM
MET WITH:Ofelia NebridaTIME COMPLETED:
10:19 AM
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On 1/26/23, Licensing Program Analyst (LPA) M. Medina conducted an unannounced Annual Required Inspection on this date. LPA allowed entrance by Direct Care Staff. LPA entered through a central entry point and observed a screening sign-sheet and PPE precautionary measures in place. Administrator, Ofelia Nebrida was present and available to conduct inspection with LPA.

Five (5) residents present during today's visit. Residents observed to be participating in day program activities with staff.

Facility appears clean, odor free, and at a comfortable temperature. Sufficient lighting and seating in all common areas. Resident bedrooms have all required furnishings. Linen is sufficient and in good repair. Perishable and non-perishable food supply is sufficient to meet client's needs. Resident bathrooms toured, all fixtures observed operational. LPA observed medication to be locked and stored in kitchen cabinet. Fire extinguisher is present and has a service date of 8/21/22. All chemicals are locked and secured under kitchen sink, additional supply is locked and secured in garage.

All fire exits open freely and observed to free of obstruction. No hazards observed.

LPA received a current copy of Administrator certificate during inspection.

Through LPA’s observations, documentation and record review, the required infection control practices are found to be in compliance. No deficiencies cited during today’s inspection. A copy of this report provided for facility records.
SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Melinda Medina
LICENSING EVALUATOR SIGNATURE: DATE: 01/26/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/26/2023
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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