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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157209346
Report Date: 12/05/2023
Date Signed: 12/05/2023 12:28:12 PM

Document Has Been Signed on 12/05/2023 12:28 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:SEASONED ELITE ASSISTED LIVINGFACILITY NUMBER:
157209346
ADMINISTRATOR:COOPER-EDISON, ALISONFACILITY TYPE:
740
ADDRESS:13403 DALI AVE.TELEPHONE:
(661) 829-7836
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93314
CAPACITY: 6CENSUS: 0DATE:
12/05/2023
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:Administrator, Alison Cooper-EdisonTIME COMPLETED:
12:42 PM
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On 12/5/2023, Licensing Program Analyst (LPA) Walton arrived for an announced Pre-Licensing / Component III inspection. LPA introduced self, stated the purpose of the visit and was granted entry to the facility. LPA met with Licensee / Administrator, Alison Cooper-Edison.

The facility is a 4 bedroom and 3 bathroom home. Fire clearance was granted for 2 Ambulatory, 2 Non-Ambulatory, and 2 bedridden for a total capacity of 6.

LPA toured the facility. Common areas were furnished and had adequate seating and lighting available. Resident bedrooms were checked. LPA did not observe chairs in the resident rooms. Resident bathrooms were checked. Bathrooms observed to be equipped with grab bars. Hot water measured at 109.7 degrees F in the hall way bathroom and 114.0 degrees F, in the bathroom near bedroom 3. LPA observed an extra supply of bed linens and personal hygiene products. Kitchen was toured and observed to have dishes, plates, and utensils. Cleaning supplies and chemicals were observed in a locked cabinet under the kitchen sink. Medications will be locked in a hall closet. First aid kit was observed and contained all required items. A fire extinguisher was observed and has a service date of 09/15/2022. Smoke detectors and carbon monoxide detector were observed to be operational.

Outside of facility toured. Exits were open and free of obstructions. LPA observed side gate to be self-latching.

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

LPA is requesting the following items to be corrected:

  • Ensure resident bedrooms are furnished with chairs
  • Have the fire extinguisher serviced

Licensee agreed to submit proof to LPA once with the above items have been corrected.

LPA will notify CAB that facility is ready to be licensed once the above information has been received.

SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Alexandria Walton
LICENSING EVALUATOR SIGNATURE: DATE: 12/05/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/05/2023
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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