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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 153808928
Report Date: 12/11/2019
Date Signed: 12/11/2019 03:07:07 PM

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME:SPECIAL EXPLORERS CENTERFACILITY NUMBER:
153808928
ADMINISTRATOR:BOWDEN, DAMIANFACILITY TYPE:
840
ADDRESS:401 19TH STREETTELEPHONE:
(661) 703-9176
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93301
CAPACITY:30CENSUS: 19DATE:
12/11/2019
TYPE OF VISIT:Annual/RandomUNANNOUNCEDTIME BEGAN:
02:00 PM
MET WITH:Evelyn Hernandez - General ManagerTIME COMPLETED:
03:00 PM
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On this date, Licensing Program Analyst (LPA) Jessika Thompson conducted an unannounced case management inspection at the facility. LPA met with General Manager Evelyn Hernandez to discuss a Confirmation of Removal form that was mailed to the Licensee's mailing address from Department of Social Services, Caregiver Background Check Bureau, regarding Mayra Pulido. LPA toured the facility and a census was taken.

LPA provided Ms. Hernandez a copy of Confirmation of Removal form Ms. Pulido. Ms. Hernandez indicated that this individual was never hired, nor has she been on the premises. LPA informed Ms. Hernandez that the Department has denied the criminal record exemption for Ms. Pulido. Ms. Hernandez confirmed that she understands that Ms. Pulido is not allowed on the premises, or around children in care, in any capacity.

Based on evidence obtained during today’s visit, LPA has verified that Ms. Pulido is not present or employed at the facility. LPA has advised Ms. Hernandez to disassociate Ms. Pulido from the Facility Personnel Record. Verification of removal is complete.

Per California Code of Regulations, Title 22, Division 12, Chapter 1, no deficiencies were cited.

An exit interview was conducted with General Manager Evelyn Hernandez. A copy of this report was provided and discussed.

A Notice of Site Visit Form was posted on parent's board and must remain posted for 30 days.
SUPERVISOR'S NAME: Diana deLeonTELEPHONE: (559) 650-7854
LICENSING EVALUATOR NAME: Jessika ThompsonTELEPHONE: 559-341-4622
LICENSING EVALUATOR SIGNATURE:

DATE: 12/11/2019
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 12/11/2019
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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