Senior Care Records.

Facility Evaluation Report

Kimberly's Family Home, Olivehurst09/28/2023Licence 585002917

Capacity4
Census4
Date signed09/28/2023 02:21:24 PM
The inspector’s account

LPA Hiratsuka conducted this unannounced annual visit. LPA toured with Administrator Kim Kennedy.

This main entrance opens to the main sitting room. The kitchen, nook, and office with a full bathroom are to the right of the main entrance. There is a staff bedroom next to the nook area. There is a hallway that leads to the back of the facility. The hallway leads to four private resident rooms and one sitting area. The sitting area has a full bathroom. There is an exit in the sitting are as well. The backyard has a shed in one corner.

Two resident files and two staff files were reviewed.

The following shall be updated and submitted to Community Care Licensing by 10/15/2023:

-LIC 500 facility personnel or staff schedule

-LIC 308 designation of administrative responsibility

Source: California Department of Social Services, Community Care Licensing. Methodology · Report a correction