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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157203519
Report Date: 03/22/2025
Date Signed: 03/22/2025 02:37:54 PM

Document Has Been Signed on 03/22/2025 02:37 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:INDEPENDENCE AT CENTENNIAL GROVEFACILITY NUMBER:
157203519
ADMINISTRATOR/
DIRECTOR:		CORONADO ERICFACILITY TYPE:
735
ADDRESS:8218 MAPLE GROVE LNTELEPHONE:
(661) 587-9499
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93312
CAPACITY: 4CENSUS: 3DATE:
03/22/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:41 AM
MET WITH:Eric CoronadoTIME VISIT/
INSPECTION COMPLETED:
02:55 PM
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On 3/22/2025, Licensing Program Analyst (LPA) M. Medina conduced an unannounced Annual Required Inspection. LPA arrived, stated purpose of visit, provided badge, and allowed entrance by Direct Care Staff. Also, present were Eric Coronado, Administrator and Breanne Perez, House Manager

LPA observed facility to be clean, well lit, and odor free. Home is 4 bedroom, 2 bathroom home, all bedrooms are private. All individuals were present at time of inspection. Facility tour conducted with Direct Care Staff. LPA observed both living room and dining room to have adequate seating for individuals in care. Bedrooms toured, all bedrooms observed to be clean, and have required accommodations available. Bathrooms toured, all fixtures observed operational. Water temperature measured at 115 degrees F. Kitchen toured, all knives observed to be locked and secured in a safe that is stored in pantry. Facility observed to have a 2-day supply of perishable and a 7-day supply of non-perishable food available. Medications observed to be locked and secured in medication cart. Medications observed to have original labels and to be administered as prescribed. Centrally stored medication log observed to have all current medications properly documented with required information.

Per review of facility records, the last fire drill was conducted 3/06/2025, and the last disaster drill was conducted 2/02/2025 according to facility records. Fire extinguisher present with a service date 11/06/2024. All chemicals are locked and stored under kitchen sink and laundry room.

Outside of facility tour. All exits observed to be free of hazard. Designated fire exit observed to be free of obstruction. Adequate shaded area and seating observed to be available outdoors on the patio. Shed observed to be locked and secured and inaccessible.

No deficiencies observed. Exit interview conducted and a copy of report provided for facility records.
SUPERVISORS NAME: Alexandria Walton
LICENSING EVALUATOR NAME: Melinda Medina
LICENSING EVALUATOR SIGNATURE: DATE: 03/22/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/22/2025
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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