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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157202608
Report Date: 07/20/2023
Date Signed: 07/20/2023 10:34:56 AM

Document Has Been Signed on 07/20/2023 10:34 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:M.P. HOMESFACILITY NUMBER:
157202608
ADMINISTRATOR:PENAREJO,M.&MANDA,G.FACILITY TYPE:
735
ADDRESS:2700 SILVER DRIVETELEPHONE:
(661) 832-3424
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93306
CAPACITY: 6CENSUS: 4DATE:
07/20/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:House Manager Joe WashingtonTIME COMPLETED:
10:45 AM
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Licensing Program Analyst (LPA) Shawna Doucette arrived at the facility unannounced to conduct a case management regarding a report that came in on 07/17/23 about a incident with C1 requiring hospitalization. There was no answer at the door. LPA made contact with the Administrator via telephone, who stated the House Manager would be responding. LPA met with House Manager Joe Washington who responded to the facility to assist with the visit.

LPA requested copies of C1's LIC 602, IPP and Admissions Agreement. LPA interviewed staff. LPA requested copies of medical records for C1 for the hospitalization that occurred on 07/17/23.

Due to requesting additional information which needs to be reviewed, LPA will return at a later date to determine if citations will be issued.


An exit interview was conducted with House Manager Joe Washington and a copy of this report was provided.
SUPERVISORS NAME: Sergiy Pidgirny
LICENSING EVALUATOR NAME: Shawna Doucette
LICENSING EVALUATOR SIGNATURE: DATE: 07/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/20/2023
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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