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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157204045
Report Date: 01/31/2023
Date Signed: 01/31/2023 01:07:56 PM


Document Has Been Signed on 01/31/2023 01:07 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:IZENE'S HAVEN ASSISTED LIVINGFACILITY NUMBER:
157204045
ADMINISTRATOR:BRUTON, MARGUERITEFACILITY TYPE:
740
ADDRESS:10000 COBBLESTONE AVETELEPHONE:
(661) 664-0125
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93311
CAPACITY:6CENSUS: 4DATE:
01/31/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
12:24 PM
MET WITH:Marguerite Bruton,AdministratorTIME COMPLETED:
01:20 PM
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On 01/31/23, Licensing Program Analyst (LPA) Yang arrived unannounced to conduct a case management inspection. LPA introduced self, stated the purpose of the visit and was greet by the Administrator Marguerite Bruton. LPA was granted entry by Administrator.

The purpose of today's visit is to obtain copies of record. LPA conducted interview with Administrator.
The information provide will be reviewed; a follow up case management will be conducted if necessary.

No deficiencies issued during today's inspection.

Exit interview conducted. A copy of this report was provided to Administrator, Marguerite Bruton, whose signature on this form confirms receipt of this document.
SUPERVISOR'S NAME: Melinda HoffmannTELEPHONE: (559) 341-3274
LICENSING EVALUATOR NAME: Mai YangTELEPHONE: 559-772-7402
LICENSING EVALUATOR SIGNATURE:
DATE: 01/31/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/31/2023
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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