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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 150406456
Report Date: 02/28/2024
Date Signed: 02/28/2024 12:39:23 PM

Document Has Been Signed on 02/28/2024 12:39 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
FRESNO RO, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME:CENTRE VILLAGEFACILITY NUMBER:
150406456
ADMINISTRATOR:RODRIGUEZ LOPEZ, NORAFACILITY TYPE:
735
ADDRESS:2500 GOSFORD ROADTELEPHONE:
(661) 836-2500
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93309
CAPACITY: 76CENSUS: 62DATE:
02/28/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:47 AM
MET WITH:Nora Rodriguez LopezTIME COMPLETED:
12:50 PM
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This Licensing Program Analyst (LPA), M. Flores conducted a Case Management visit in response to incident reports sent to the Department by the facility dated 2/23/24, 2/24/2024, and 2/25/24. LPA met with Administrator, Nora Rodriguez Lopez.

LPA completed file reviews for R1, R2, and R3. Administrator agreed to sent Hospital Medical Records for R3 by 3/1/24.

No citations were given at this time. Further investigation is required.

An exit interview was conducted and a copy of this report was provided to Administrator, Nora Rodriguez Lopez.
SUPERVISORS NAME: Sergiy Pidgirny
LICENSING EVALUATOR NAME: Miriam Flores
LICENSING EVALUATOR SIGNATURE: DATE: 02/28/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/28/2024
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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