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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157201011
Report Date: 06/14/2023
Date Signed: 06/15/2023 02:58:33 PM

Document Has Been Signed on 06/15/2023 02:58 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
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:
06/14/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
02:20 PM
MET WITH:House Manager, Rosemarie DeJesus
Administrator, Adam Tauchen		TIME COMPLETED:
04:15 PM
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Licensing Program Analyst (LPA) Darius Williams conducted an unannounced annual inspection visit. LPA Williams met with staff Evelyn Marcelino and discussed the purpose of the visit. House Manager Rosemarie DeJesus and Administrator Adam Tauchen arrived shortly after.

LPA Williams toured the facility with staff.

The facility thermostat reflected 77 degrees Fahrenheit. The living room and dining room were clean, in good repair, and had seating available for all clients.

The kitchen was clean, in good repair, and free of any odor.

Four bedrooms were toured. All bedrooms had a bed (with all required linen), dresser, chair, working lights, and free of obstruction. Extra linens were available as needed.

Two bathrooms were toured. Both bathrooms were clean and in good repair. There were grab bars and non-slip mats available for client use.

The backyard main area of the backyard was free of obstruction. The facility no longer has a pool on the premises.

Chemicals and medications were observed locked and inaccessible to clients.

*Continued on LIC 809-C*
SUPERVISORS NAME: Serigy Pidgirny
LICENSING EVALUATOR NAME: Darius Williams
LICENSING EVALUATOR SIGNATURE: DATE: 06/07/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/07/2023
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME: MERCIE'S HOME
FACILITY NUMBER: 157201011
VISIT DATE: 06/14/2023
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Smoke detector, carbon monoxide, and fire extinguishers were present and operational.

LPA Williams reviewed 3 clients files and 3 staff files. All three staff files had documents requested by the LPA. All three clients had documents requested by the LPA.

No deficiencies were cited during this visit.

An exit interview was conducted and a copy of this report will be provided via e-mail.
SUPERVISORS NAME: Serigy Pidgirny
LICENSING EVALUATOR NAME: Darius Williams
LICENSING EVALUATOR SIGNATURE:

DATE: 06/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/14/2023
LIC809 (FAS) - (06/04)
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