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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157208767
Report Date: 12/21/2022
Date Signed: 12/22/2022 07:08:07 AM

Document Has Been Signed on 12/22/2022 07:08 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:BETHANY JOY GARDENFACILITY NUMBER:
157208767
ADMINISTRATOR:ESTOMATA, RIZANIO BFACILITY TYPE:
740
ADDRESS:12302 RAMBLER AVENUETELEPHONE:
(661) 615-3897
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93312
CAPACITY: 6CENSUS: 6DATE:
12/21/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:14 PM
MET WITH:Rizanio Estomata via telephoneTIME COMPLETED:
03:45 PM
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Licensing Program Analyst (LPA) M. Medina arrived at the facility unannounced to conduct the Infection Control Inspection. LPA was greeted by Direct Care Staff, stated the purpose of the visit and was allowed entry into the facility. LPA entered through the central entry point where hand sanitizer, staff and visitor sign in sheet, and Covid symptom screening area was observed. Administrator was not available during today's inspection but confirmed that Direct Care Staff was authorized to sign report.

Facility Mitigation plan has been submitted to CCL. Infection control procedures described in the plan which were observed and reviewed by LPA include: Daily symptoms screenings (for staff, persons in care and visitors), testing, visitation, quarantine/isolation procedures, emergency staffing plan, PPE storage, use and training, as well as daily infection control procedures.

Postings to encourage face coverings and hand washing were observed. Furniture in common and dining areas are spaced to promote distancing. Staff were all observed wearing face coverings. Facility has multiple designated visitation areas available. LPA observed 30-day medication supply and PPE accessible to staff. Common and resident bathroom sinks are stocked with liquid soap and paper towels for hand washing.

Through LPA’s observation, the required infection control practices are found to be in compliance. No deficiencies cited on today’s inspection.

Exit interview conducted over telephone with Administrator and signed by caregiver. A copy of report will be emailed to Licensee and Administrator due to technical problems
SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Melinda Medina
LICENSING EVALUATOR SIGNATURE: DATE: 12/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/21/2022
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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