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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157201011
Report Date: 07/01/2022
Date Signed: 07/01/2022 10:42:27 AM

Document Has Been Signed on 07/01/2022 10:42 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:MERCIE'S HOMEFACILITY NUMBER:
157201011
ADMINISTRATOR:PENAREJO, MERCIEFACILITY TYPE:
735
ADDRESS:6000 POSO COURTTELEPHONE:
(661) 861-8805
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93309
CAPACITY: 6CENSUS: 5DATE:
07/01/2022
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
08:35 AM
MET WITH:Joseph Washington, Administrator
Gerald De Claro, Co-Administrator		TIME COMPLETED:
10:55 AM
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On 7/1/22 at 8:35 AM, Licensing Program Analyst (LPA) Malia Thao arrived unannounced to conduct a POC visit for a deficiency issued on 6/14/22. LPA explained reason for inspection and was granted entry by staff. Administrator Joseph Washington and Co-Administrator Gerald De Claro arrived a short time later. Three residents and one staff present during inspection.

LPA observed exterior fire exit gate lever installed and kitchen drawer front repaired. POC cleared.

No deficiencies cited during this inspection.

Exit interview conducted. A copy of this report was given to Administrator Joseph Washington, whose signature confirms receipt of this report.
SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Malia Thao
LICENSING EVALUATOR SIGNATURE: DATE: 07/01/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/01/2022
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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