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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157202442
Report Date: 05/24/2022
Date Signed: 05/24/2022 10:22:32 AM

Document Has Been Signed on 05/24/2022 10:22 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:ENDEAVOR IN THE WESTFACILITY NUMBER:
157202442
ADMINISTRATOR:ESPARZA, DANIELFACILITY TYPE:
735
ADDRESS:8114 RIVER HAWK LNTELEPHONE:
(661) 588-8966
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93312
CAPACITY: 4CENSUS: 3DATE:
05/24/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Administrator Daniel EsparzaTIME COMPLETED:
10:30 AM
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Licensing Program Analyst LPA conducted a Case Management to follow up on an death report on 5/20/22. LPA contacted Administrator Daniel Esparza via telephone who responded to the facility. LPA discussed the purpose of the visit.

LPA interviewed Administrator. LPA obtained the clients file to copy and will return the file by 5/26/22.


An exit interview was conducted with the Administrator a copy of this report was provided.
SUPERVISORS NAME: Sergiy Pidgirny
LICENSING EVALUATOR NAME: Shawna Doucette
LICENSING EVALUATOR SIGNATURE: DATE: 05/24/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/24/2022
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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