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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157209249
Report Date: 09/18/2024
Date Signed: 09/18/2024 12:42:28 PM

Document Has Been Signed on 09/18/2024 12:42 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:DELIAN'S MANOR SENIOR CARE LLCFACILITY NUMBER:
157209249
ADMINISTRATOR/
DIRECTOR:
DELA CRUZ, DENNISFACILITY TYPE:
740
ADDRESS:10725 RISING SUN DRIVETELEPHONE:
(661) 703-3543
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93312
CAPACITY: 6CENSUS: 6DATE:
09/18/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:35 AM
MET WITH:Dennis DeLa CruzTIME VISIT/
INSPECTION COMPLETED:
01:00 PM
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On 9/18/24, Licensing Program Analyst (LPA) M. Medina made an unannounced Annual Required Inspection visit. LPA Medina introduced self, stated purpose of visit, and allowed entrance by Caregiver. Dennis DeLa Cruz, Administrator contacted by telephone and arrived a short time later to conduct visit.

Currently, six (6) residents in care and present during today's visit. Facility tour began in resident bedrooms. Rooms observed to have all required accommodations. All areas of the facility have sufficient lighting. Residents bathrooms observed to be clean and in good repair. Bath/tub are have non-skid mats and grab bars. Hot water tested and measured at 112 degrees F. Dining room and living room have adequate seating for all residents in care. Tour of kitchen conducted. LPA observed adequate food supply for the residents in care. LPA observed leftovers stored in the refrigerator and/or freezer observed to be properly stored and labeled. Medications observed to be locked in kitchen cabinet, all medications have original labels and observed to be administered as prescribed.

Smoke detectors present and observed operational at time of visit. Carbon monoxide detector present and visible in hallway near resident bedrooms. Fire extinguisher has a service date of 7/26/24. All cleaning supplies observed to be locked in secured cabinet in laundry room.

All facility staff who require caregiver background checks have received criminal record index clearance or exemptions. Staff and resident files reviewed.

Outside areas toured. All exits open freely and observed to be free of obstruction. No hazards observed.

No deficiencies cited during visit.
SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Melinda Medina
LICENSING EVALUATOR SIGNATURE: DATE: 09/18/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/18/2024
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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