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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157209395
Report Date: 02/14/2024
Date Signed: 02/14/2024 10:18:00 AM

Document Has Been Signed on 02/14/2024 10:18 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:GARNSEY GARDENFACILITY NUMBER:
157209395
ADMINISTRATOR:LAZAGA, CECILIAFACILITY TYPE:
740
ADDRESS:364 GARNSEY AVENUETELEPHONE:
(661) 563-1761
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93309
CAPACITY: 6CENSUS: 0DATE:
02/14/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
07:51 AM
MET WITH:Licensee Cecilia and Jethronel LazagaTIME COMPLETED:
10:17 AM
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Licensing Program Analyst (LPA) Darius Williams conducted an announced visit to conduct a Pre-Licensing inspection.

Tour began on the front yard of the facility. Front yard and walk ways were free of obstruction. LPA observed required postings in the facility entrance and hallways.

The living room and dining room were clean and free of obstruction. Seating was available to accommodate 6 residents.

LPA observed 4 bedrooms. All bedrooms had mattresses, blankets, sheets, chair, dresser, lamp, and night stand. Rooms were clean and free of obstructions.

LPA observed 3 bathrooms for residents and 1 bathroom for visitors. All rooms were clean and free obstruction. Grab bars were present in all bathrooms for residents use. Non skid mats or strips were not observed in 3 of 3 residents bathrooms.

Pool is present in the backyard and secured.

Dual smoke detector and carbon monoxide was present and operation. LPA observed fire extinguishers present and charged.

First aid kit was present in the hallway and had all required items.

Licensee identified separate locked locations for medications, sharps/knives, and chemicals.

*Continued on 809-C*
SUPERVISORS NAME: Serigy Pidgirny
LICENSING EVALUATOR NAME: Darius Williams
LICENSING EVALUATOR SIGNATURE: DATE: 02/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/14/2024
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME: GARNSEY GARDEN
FACILITY NUMBER: 157209395
VISIT DATE: 02/14/2024
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LPA requested the following items to be corrected:

- Dementia and Bedridden care is required to be addressed in facilities emergency disaster plan.
- Add non-skid mats or strips were in 3 of 3 bathroom showers/tubs

Once LPA receives proof of correction, it will be forwarded to the Central Application Bureau for further review and processing.

Component III was reviewed with Licensee's

An exit interview was conducted and a copy of this report was provided to the Licensee.
SUPERVISORS NAME: Serigy Pidgirny
LICENSING EVALUATOR NAME: Darius Williams
LICENSING EVALUATOR SIGNATURE:

DATE: 02/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/14/2024
LIC809 (FAS) - (06/04)
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