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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157209268
Report Date: 12/14/2022
Date Signed: 12/14/2022 10:49:05 AM

Document Has Been Signed on 12/14/2022 10:49 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:PRECIOUS LIFE RESIDENCES LLCFACILITY NUMBER:
157209268
ADMINISTRATOR:CRISOSTOMO, PETROFACILITY TYPE:
740
ADDRESS:10414 BICHESTER COURTTELEPHONE:
(661) 472-9253
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93311
CAPACITY: 6CENSUS: 5DATE:
12/14/2022
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
09:03 AM
MET WITH:Susan Blanza, Licensee and Petro Crisostomo, AdministratorTIME COMPLETED:
11:00 AM
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On 12/14/22, Licensing Program Analysts (LPA) M. Yang conducted an announced Pre-licensing / Component III Inspection. LPA introduced self, stated the purpose of the visit and was allowed entry into the facility. LPA met with Susan Blanza, Licensee and Petro Crisostomo, Administrator.

The facility is a 5 bedroom and 3-bathroom home and fire clearance was granted for 6 Non-Ambulatory for a total capacity of 6.

There are five resident present during this inspection. LPA toured the facility with Licensee and Administrator. Facility was free from ground obstructions and odor free. Common areas were observed to have adequate seating and lighting available. Kitchen was toured and observed to have dishes, plates, and utensils. Knives will be kept locked and secure in the kitchen drawer.

Bedrooms were observed to have the required furnishing and are ready for occupancy. Hot water measured at 115.2 degrees F in bathroom 1 and ranged 116.2 to 119 degrees F in the bathroom in the shared bedroom. Cleaning supplies and chemicals observed to be locked in shelf in the laundry room. LPA observed an extra supply of bed linens and personal hygiene products. Medications will be locked in shelf near kitchen. A fire extinguisher was observed and had a service date of 07/12/22. Smoke detectors and carbon monoxide were observed to be operational during this inspection. First aid kit was observed and contained all required items. Outside of facility toured. Exits were open and free of obstructions. LPA observed side gate to be self-latching. Resident records were reviewed. LPA observed resident Admission Agreements, Physician Reports, and Pre-Appraisal.

Component III was conducted during today's pre-licensing visit.

I have found that the applicant has met all pre-licensing requirements. LPA will submit documentation to CAB in Sacramento for final review prior to license being issued.

SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Mai Yang
LICENSING EVALUATOR SIGNATURE: DATE: 12/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/14/2022
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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