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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157204034
Report Date: 04/11/2023
Date Signed: 04/11/2023 12:12:54 PM


Document Has Been Signed on 04/11/2023 12:12 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:M & L RESIDENTIAL HOMEFACILITY NUMBER:
157204034
ADMINISTRATOR:SALON, LEONIDAFACILITY TYPE:
740
ADDRESS:609 WANSTEAD LANETELEPHONE:
(661) 588-7784
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93312
CAPACITY:6CENSUS: 0DATE:
04/11/2023
TYPE OF VISIT:Case Management - Licensee InitiatedUNANNOUNCEDTIME BEGAN:
11:56 AM
MET WITH:Leonida SalonTIME COMPLETED:
12:27 PM
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Licensing Program Licensing (LPA) Medina arrived at the facility announced to conduct an Case Management visit. LPA met with Licensee Leonida Salon.

LPA Medina was contacted by Licensee on 03/31/2023 that all residents were relocated by family members.

Facility toured, all client bedrooms are vacant and LPA observed no personal belongings of clients in facility.

LPA provided with information with regards to client's placement and licensee relinquished license during today's inspection.

No deficiencies cited during visit.
SUPERVISOR'S NAME: Melinda HoffmannTELEPHONE: (559) 341-3247
LICENSING EVALUATOR NAME: Melinda MedinaTELEPHONE: (559) 410-5914
LICENSING EVALUATOR SIGNATURE:
DATE: 04/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/11/2023
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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