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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157206916
Report Date: 09/25/2024
Date Signed: 09/25/2024 05:31:10 PM

Document Has Been Signed on 09/25/2024 05:31 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:VILLAGE GARDENSFACILITY NUMBER:
157206916
ADMINISTRATOR/
DIRECTOR:		DIANNA L ELLISFACILITY TYPE:
740
ADDRESS:11910 CROCKETT COURTTELEPHONE:
(661) 587-1191
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93312
CAPACITY: 6CENSUS: 6DATE:
09/25/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:30 PM
MET WITH:Margaret GardeaTIME VISIT/
INSPECTION COMPLETED:
05:50 PM
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On 9/25/24, Licensing Program Analysts (LPAs) M. Medina and L. Salazar conducted an unannounced Annual Required Inspection. LPAs arrived, introduced self, stated purpose of visit, and allowed entrance by Direct Care Staff. House Manager, Margaret Gardea contacted by telephone and arrived a short time later to conduct facility inspection.

Facility tour conducted. Facility observed to be odor free, well lit, and a comfortable temperature. Facility tour began in kitchen. Facility observed to have a 2-day supply of perishable food and a 7-day of non-perishable food available. All kitchen dives observed to be locked and secured in the medication cabinet. Resident bedroom toured, all bedrooms observed to have required furnishings available. Resident bathrooms toured. Bathroom observed to have operational fixtures, shower/bathtub have shower chairs, grab bars, and non-skid mats available. Water temperature measured at 119 degrees F. Medications observed to be locked and secured in cabinet. Medications observed to have original labels and be administered as prescribed.

All chemicals observed to be locked, secured, and inaccessible to residents. Fire extinguisher present with a purchase date of 12/18/2023. Carbon monoxide detector present and observed operational. Facility is equipped with a pull station.

Outside of facility toured. Exit gate observed to be self-latching and observed free of obstruction. Pool is surrounded by 5 foot fence and observed to be locked, secured, and inaccessible to residents.

Due to time constraints, inspection will be continued at a later date to review staff and resident files, as well as inspection tool.

No deficiencies cited during inspection.
SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Melinda Medina
LICENSING EVALUATOR SIGNATURE: DATE: 09/25/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/25/2024
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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