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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157206575
Report Date: 10/15/2024
Date Signed: 10/15/2024 12:22:36 PM

Document Has Been Signed on 10/15/2024 12:22 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:DEAN'S CARE VILLA 110FACILITY NUMBER:
157206575
ADMINISTRATOR/
DIRECTOR:		SANTA MARIA, ELVIRA PFACILITY TYPE:
740
ADDRESS:13110 HINAULT DRIVETELEPHONE:
(661) 218-9151
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93314
CAPACITY: 6CENSUS: 6DATE:
10/15/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:27 AM
MET WITH:Licensee, John NoblezaTIME VISIT/
INSPECTION COMPLETED:
12:33 PM
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On 10/15/2024, Licensing Program Analyst (LPA) Walton arrived unannounced to conduct an annual inspection. LPA introduced self, stated the purpose of the visit and was granted entry to the facility. LPA met with Licensee, John Nobleza.

LPA reviewed facility records and observed the following: Resident records were found to be complete. Personnel records were found to be complete. Emergency Disaster plan and Infection control plan reviewed. Last fire drill was conducted on 06/25/2024. Fire extinguisher was last serviced on 07/26/2024.

LPA conducted a tour of the facility with Licensee. Common areas were observed to have required furnishings and adequate lighting. LPA toured resident bedrooms. LPA observed resident bedrooms to have required furnishings. Resident bathrooms toured and observed to be operational. Bathrooms were properly equipped with securely fastened grab bars in toilet and tub/shower areas, non-skid mats were observed. Hot water measured at 106.8 degrees F. Smoke detector and carbon monoxide detector were tested and observed to be operational. LPA toured the facility kitchen. Kitchen appeared clean and safe for food preparation. LPA observed an adequate food supply. Exterior tour conducted. All exits were open and free from obstructions. Side gate was observed to be self-latching.

No deficiencies issued during today's inspection.

Exit interview conducted. A copy of this report was discussed and provided to Licensee, John Nobleza, whose signature on this form confirms receipt of this document.

LPA is requesting the following documents be submitted to the Fresno CCL office by 10/29/2024: Current copy of Administrator Certificate, Designation of Facility Responsibility (LIC308), Administrator Organization (LIC 309), Affidavit regarding Client/Resident Cash Resources (LIC 400), Liability Insurance, Emergency and Disaster Plan (LIC 610E) Personnel Report (LIC500), Register of Facility Clients/Residents for (LIC9020A), Surety Bond

SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Alexandria Walton
LICENSING EVALUATOR SIGNATURE: DATE: 10/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/15/2024
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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