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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 155801189
Report Date: 01/07/2022
Date Signed: 01/31/2022 02:25:39 PM

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:WESTCHESTER GARDENSFACILITY NUMBER:
155801189
ADMINISTRATOR:ROBINSON, SHERVETAFACILITY TYPE:
740
ADDRESS:2228 TRUXTUN AVETELEPHONE:
(661) 324-3091
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93301
CAPACITY:36CENSUS: 13DATE:
01/07/2022
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
03:37 PM
MET WITH:Administrator, Sherveta RobinsonTIME COMPLETED:
05:33 PM
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On 1/7/2022 Licensing Program Analysts, M. Garza and L. Salazar arrived at facility unannounced to complete a case management visit to collect documentation on various Incident Reports. LPA's were screened and permitted entry into facility. LPAs met with with Administrator, Sherveta Robinson and discussed reason for visit.

LPA's toured facility to complete a health and safety check on residents in care. Residents observed in dining area and in rooms.

No deficiencies cited during todays visits. Due to time constraints will return at a later date.
SUPERVISOR'S NAME: Melinda HoffmannTELEPHONE: (559) 650-7914
LICENSING EVALUATOR NAME: Mary GarzaTELEPHONE: (559) 365-9009
LICENSING EVALUATOR SIGNATURE:

DATE: 01/07/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 01/07/2022
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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