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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157202487
Report Date: 08/08/2025
Date Signed: 08/08/2025 02:47:58 PM

Document Has Been Signed on 08/08/2025 02:47 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
FRESNO RO, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME:MISSION WELLS, INC. SADDLEBACKFACILITY NUMBER:
157202487
ADMINISTRATOR/
DIRECTOR:		RAMIREZ, CLAUDIAFACILITY TYPE:
735
ADDRESS:7008 SADDLEBACK DR.TELEPHONE:
(661) 832-3400
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93309
CAPACITY: 5CENSUS: 4DATE:
08/08/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:30 AM
MET WITH:Claudia Yvonne RamirezTIME VISIT/
INSPECTION COMPLETED:
02:45 PM
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On 8/8/25, Licensing Program Analysts (LPA) J. Duarte conducted an unannounced Annual Required Inspection. LPA arrived, introduced self, stated purpose of visit, and allowed entrance by Care Giver Jessica Tibuyen. Care Giver Tibuyen contacted Administrator (AD) Claudia Yvonne Ramirez via telephone to advise CCL was conducting an annual inspection. House Manager (HM) Desireee Sales, AD Ramirez. and Administrative Assistant Crystianna Robynson arrived shortly after. Only one resident was in the facility and staff stated that the other three residents were at the day program.

LPA observed facility to be clean, odor free, and at a temperature to be 75 degrees F. Resident rooms toured. Rooms were observed to have all required furnishings. All common areas observed to have adequate seating available for residents. Bathrooms observed to have grab bars, shower chairs, and non-skid mats available. Fixtures in the bathroom observed to be functional. Water temperature in the hallway measured at 107.2 degrees F and the hot water for the restroom inside the bedroom measured at 105.7 degrees F.

LPA toured the Kitchen. The hot water in the kitchen sink measured at 113.5 degrees F. The facility had a seven day supply of non-perishable food and a two day supply of perishable food available. The garage has three refrigerators with an additional food supply. The garage also has a washer and dryer for in house laundry. Medication is stored in locked kitchen cabinet. Knifes are also stored in a locked kitchen cabinet next to the dishwasher. Chemical were observed locked in the cabinet under the kitchen sink.

LPA observed smoke detectors and carbon monoxide detectors to be operational during facility inspection. Two fire extinguishers were present with a service date of 5/14/25. There were no obstructions in passageways or exits. Per facility records, the last fire drill was conducted on 7/10/25.
NAME OF LICENSING PROGRAM MANAGER: Serigy Pidgirny
NAME OF LICENSING PROGRAM ANALYST: Jimmy Duarte
LICENSING PROGRAM ANALYST SIGNATURE: DATE: 08/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/08/2025
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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California Health & Human Services Agency
California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:
  • Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.
  • Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)
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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
FRESNO RO, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME: MISSION WELLS, INC. SADDLEBACK
FACILITY NUMBER: 157202487
VISIT DATE: 08/08/2025
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Continued from LIC 809.

Outside of facility toured. Pool is surrounded with a wrought iron fence, observed to be locked, secured, and inaccessible to residents. The house has an attached patio to residence in the backyard with seating and tables available for residents. The side gate has deadbolt that can be secured on the inside, with no key required to open the gate.

LPA reviewed two staff files and two resident files. Staff and resident files had all required forms. LPA also reviewed medications and MARS for two residents and per the logs, medication was administered as prescribed. Safeguards for Cash Resource for one resident was reviewed and observed to be complete.

No deficiencies were cited during this inspection.

An exit interview was conducted with AD Ramirez and a copy of this report was provided. Community Care Licensing (CCL) is always striving to have facility files that reflect the most accurate & up to date information for your facility. To maintain your facility file, please submit the most current & complete forms &/or information as identified below:

Adult Residential Facility (ARF):



· LIC 308 Designation of Facility Responsibility
· -as applicable: LIC 309 Administrative Organization
· -as applicable: LIC 400 Affidavit Regarding Client/Resident Cash Resources
· -as applicable: LIC 402 Surety Bond
· LIC 500 Personnel Report
· LIC 610D Emergency Disaster Plan For Adult Residential Facilities
· LIC 9020 Register of Facility Clients/Residents
· Copy of current Administrator Certificate
· Alternate contact information including name, telephone number, & email address.***Also include updated faciliy sketch to reflect emergency exits.

Please submit the above listed forms/information to Fresno CCL by: 08/15/2025.
NAME OF LICENSING PROGRAM MANAGER: Serigy Pidgirny
NAME OF LICENSING PROGRAM ANALYST: Jimmy Duarte
LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 08/08/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 08/08/2025
LIC809 (FAS) - (06/04)
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