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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157203246
Report Date: 04/10/2023
Date Signed: 04/10/2023 01:27:40 PM

Document Has Been Signed on 04/10/2023 01:27 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:E & E RESIDENTIAL #2FACILITY NUMBER:
157203246
ADMINISTRATOR:NELSON, BRIANFACILITY TYPE:
735
ADDRESS:8917 ELLENSPORTTELEPHONE:
(661) 831-6209
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93313
CAPACITY: 5CENSUS: 5DATE:
04/10/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
12:45 PM
MET WITH:Administrator Sophia NelsonTIME COMPLETED:
01:45 PM
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Licensing Program Analyst (LPA) Shawna Doucette arrived at the facility to conduct a case management inspection regarding an incident of AWOL that occurred on 4/4/23. LPA met with Administrator Sophia Nelson.

LPA reviewed C1 records and interviewed Administrator. C1's 602 states C1 can leave facility unassisted. Administrator contacted Bakersfield PD 23-64093 to file a missing persons report.

No deficiencies.

An exit interview was conducted with Administrator Sophia Nelson and a copy of this report was provided.

SUPERVISORS NAME: Sergiy Pidgirny
LICENSING EVALUATOR NAME: Shawna Doucette
LICENSING EVALUATOR SIGNATURE: DATE: 04/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/10/2023
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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