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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157203246
Report Date: 10/21/2023
Date Signed: 10/21/2023 11:47:13 AM

Document Has Been Signed on 10/21/2023 11:47 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: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:
10/21/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:45 AM
MET WITH:Staff Gricelda Rubio and House Manager Elizabeth LunaTIME COMPLETED:
12:00 PM
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Licensing Program Analyst (LPA) Shawna Doucette arrived at the facility unannounced to conduct an Annual Inspection. LPA was granted entry by Staff Gricelda Rubio. Staff Gricelda Rubio contacted Administrator Brian Nelson who gave permission for Staff Gricelda Rubio. House Manager Elizabeth Luna responded to assist with the visit. The original inspection produced a replication error. LPA had to produce an additional report as it did not show in the system.

LPA conducted a tour inside and outside of facility. Facility observed to be clean, and at a comfortable temperature. Common areas were furnished well with adequate seating and lighting available. Kitchen toured, appeared clean and safe for food preparation. Food supply checked, LPA observed an adequate supply of food. Resident rooms checked. LPA observed an adequate supply of linen. Hot water measured at 109.6 degrees F. Facility was set at 75 F. Exterior tour conducted, all exits open and free of obstructions. Side gate was observed to be self-latching.

Fire extinguisher serviced on 07/23/2023. Smoke detectors and carbon monoxide detectors observed operational during today’s inspection. Facility has a pull station fire alarm. Last fire drill conducted 10/02/2023. All cleaning supplies are locked and secured in a cabinet in the garage.

An exit interview was conducted with the House Manager and a copy of this report was provided.
SUPERVISORS NAME: Sergiy Pidgirny
LICENSING EVALUATOR NAME: Shawna Doucette
LICENSING EVALUATOR SIGNATURE: DATE: 10/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/21/2023
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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