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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157202442
Report Date: 05/25/2022
Date Signed: 05/25/2022 09:42:03 AM

Document Has Been Signed on 05/25/2022 09:42 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: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:
05/25/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:30 AM
MET WITH:Administrator Daniel EsparzaTIME COMPLETED:
10:00 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 met with Administrator Daniel Esparza and discussed the purpose of the visit.

LPA returned the clients file on 5/25/22.


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: 05/25/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/25/2022
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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