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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157200335
Report Date: 10/09/2024
Date Signed: 10/09/2024 11:40:21 AM


Document Has Been Signed on 10/09/2024 11:40 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:PASSION PLUS CARE HAVEN RES. CARE FAC.FOR ELDERLYFACILITY NUMBER:
157200335
ADMINISTRATOR:GRIDIRON, HAROLD & JAMESIEFACILITY TYPE:
740
ADDRESS:3025 LOTUS LANETELEPHONE:
(661) 831-0908
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93307
CAPACITY:6CENSUS: 0DATE:
10/09/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:05 AM
MET WITH:Jamesie GridironTIME COMPLETED:
11:50 AM
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On 10/09/2024, Licensing Program Analyst (LPA) M. Medina conducted an unannounced required Annual Inspection. LPA arrived, introduced self, stated purpose of visit, and allowed entrance by Licensee, Jamesie Gridiron to conduct inspection.

There are currently no clients in care. Facility tour began in resident bedrooms, bedrooms observed to be vacant with no personal belongings. Kitchen toured, kitchen observed to be stocked with plates, cups, and utensils for residents. Facility has a 7-day supply of non-perishable food available. All common areas observed to have adequate seating and lighting available for residents. Bathrooms toured, LPA observed fixtures to be operational. Tub/Shower area is equipped with grab bar and shower chair.

Fire extinguishers present and current. Smoke detectors present and observed operational during inspection.

Facility exits open free of obstruction.

Licensee to submit current copy of Administrator certificate and CPR card to Fresno Regional Office no later than 10/18/2024.

No deficiencies cited during inspection.






i
SUPERVISOR'S NAME: Melinda HoffmannTELEPHONE: (559) 341-3247
LICENSING EVALUATOR NAME: Melinda MedinaTELEPHONE: (559) 410-5914
LICENSING EVALUATOR SIGNATURE:
DATE: 10/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/09/2024
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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