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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157209346
Report Date: 11/08/2024
Date Signed: 11/08/2024 03:19:56 PM


COMPREHENSIVE INSPECTION

Document Has Been Signed on 11/08/2024 03:19 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:SEASONED ELITE ASSISTED LIVINGFACILITY NUMBER:
157209346
ADMINISTRATOR/
DIRECTOR:		COOPER-EDISON, ALISONFACILITY TYPE:
740
ADDRESS:13403 DALI AVE.TELEPHONE:
(661) 829-7836
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93314
CAPACITY: 6CENSUS: 0DATE:
11/08/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:08 AM
MET WITH:Administrator, Alison Cooper-EdisonTIME VISIT/
INSPECTION COMPLETED:
11:53 AM
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On 11/08/2024, Licensing Program Analyst (LPA) Walton arrived unannounced to conduct an annual inspection. LPA introduced self, stated the purpose of the visit and was granted entry to the facility. LPA met with Administrator, Alison Cooper-Edison.

There are currently no residents in care at this facility and the facility is not staffed.

LPA conducted a facility tour with Administrator. Facility appeared clean, odor free, and at a comfortable temperature. LPA observed required postings at the entrance to the facility and reviewed the emergency disaster plan. Common areas were furnished with adequate seating and LPA observed adequate lighting in the living room area/dining room area. Kitchen was toured and observed to be safe for food preparation. The facility will maintain a 7 day supply of non-perishable foods and a 2-day supply of perishable foods, upon admission of a resident. Kitchen was observed to have dishes, plates, and utensils. Resident bedrooms were observed to have required furnishings and ready for occupancy. Resident bathrooms were operational and were equipped with securely fastened grab-bars and non-skid mats. LPA observed an adequate linen supply and cleaning supplies was observed to be locked and inaccessible. First-aid kit observed. Smoke detector and carbon monoxide detector observed to be operational.

Exterior tour conducted. All exits open and free from obstructions.

No deficiencies issued during today's inspection. Exit interview conducted. A copy of this report was discussed and provided to Administrator, Alison Cooper-Edison, via email due to technical difficulties during the inspection. Facility Representative signature on file.

LPA is requesting the following documents be submitted to the Fresno CCL office via fax or mail by 11/22/2024: Current copy of Administrator Certificate, Designation of Facility Responsibility (LIC308), Administrator Organization (LIC 309), Affidavit regarding Client/Resident Cash Resources (LIC 400), Liability Insurance, Emergency and Disaster Plan (LIC 610E) Personnel Report (LIC500), Register of Facility Clients/Residents for (LIC9020A), Surety Bond.
SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Alexandria Walton
LICENSING EVALUATOR SIGNATURE: DATE: 11/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/08/2024
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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