<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157203246
Report Date: 07/09/2024
Date Signed: 07/10/2024 08:12:53 AM

Document Has Been Signed on 07/10/2024 08:12 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/
DIRECTOR:		NELSON, BRIANFACILITY TYPE:
735
ADDRESS:8917 ELLENSPORTTELEPHONE:
(661) 831-6209
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93313
CAPACITY: 5CENSUS: 4DATE:
07/09/2024
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:07 PM
MET WITH:Administrator Sophia NelsonTIME VISIT/
INSPECTION COMPLETED:
02:15 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) Shawna Doucette arrived at the facility to conduct a case management Health and Safety check regarding an incident that occurred on 7/4/24 resulting in a hospitalization. LPA met with Administrator Sophia Nelson.


LPA conducted a health and safety check. All clients were at day program. LPA requested copy of medication list. C1 did not take any medications. LPA obtained a copy of the staff schedule. LPA obtained a copy of the death report.


A copy of this report was provided.
SUPERVISORS NAME: Sergiy Pidgirny
LICENSING EVALUATOR NAME: Shawna Doucette
LICENSING EVALUATOR SIGNATURE: DATE: 07/09/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/09/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1