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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157208817
Report Date: 06/13/2022
Date Signed: 06/13/2022 12:19:29 PM

Document Has Been Signed on 06/13/2022 12:19 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:BOGGS FACILITYFACILITY NUMBER:
157208817
ADMINISTRATOR:MARCUS HUFFFACILITY TYPE:
740
ADDRESS:810 DARLINGHAM COURTTELEPHONE:
(661) 282-1438
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93312
CAPACITY: 4CENSUS: 4DATE:
06/13/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:36 AM
MET WITH:Sharon Thomas
Kelly Wejmar
TIME COMPLETED:
12:28 PM
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On 6/13/2022, Licensing Program Analyst (LPA) M. Medina conducted an unannounced Annual Required Inspection. LPA arrived, introduced self and allowed entrance by Direct Support Professional (DSP), Aaronette Woolfolk. House Manager, Kelly Wejmar contacted by telephone and arrived a short time later to conduct facility inspection. Also present, Sharon Thomas, Administrator. A tour of the facility was conducted with DSP. COVID-19 guidelines are in place. Visitor log-in/temperature check was observed upon entry. Facility has one entrance/exit point, all staff and visitors enter through front door.

Facility appeared clean with no obstruction or fire clearance issues. Hand sanitizer was readily available to resident and visitors. Social distancing is maintained in the common and dining areas. Bathrooms have trash cans with lid. Hand washing posters were observed by the bathroom sink. Resident bedrooms toured, all resident bedrooms are private. .

Fire extinguisher present and has a purchase date of 07/06/2021. Carbon monoxide detector and smoke detectors present and observed to be operational during today's inspection.

Food supply was observed to be adequate for residents in care. Cleaning and PPE supplies are locked and secured in laundry room. Medications and knives are locked and secured in hall closet. Residents have a 30-day supply of medication available.

Exit interview conducted. LPA left copy of facility report with Administrator.
SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Melinda Medina
LICENSING EVALUATOR SIGNATURE: DATE: 06/13/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/13/2022
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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