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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157204078
Report Date: 01/19/2024
Date Signed: 01/19/2024 01:00:00 PM

Document Has Been Signed on 01/19/2024 01:00 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:CELINE'S VILLAFACILITY NUMBER:
157204078
ADMINISTRATOR:SILVA, WENDYFACILITY TYPE:
735
ADDRESS:3621 KAPRAL WAYTELEPHONE:
(661) 564-8889
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93309
CAPACITY: 4CENSUS: 4DATE:
01/19/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:20 AM
MET WITH:Wendy SilvaTIME COMPLETED:
01:10 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) M. Flores arrived unannounced to conduct an annual visit. LPA introduced self, stated the purpose of the visit, and toured the facility with Licensee, Wendy Silva and Co Administrator, Morris Santamena.

The facility was observed to be at a comfortable temperature of 69 degrees F, clean and no passageway obstructions or fire hazards were observed inside or outside. An adequate supply of perishable and non-perishable food was observed. Cleaning supplies and chemicals are stored and locked under the kitchen sink and in a locked cabinet in the garage. Medications were observed and are kept locked in the hallways’ closet. All four bedrooms were observed to have the required furnishings and adequate lightening. Hot water temperature was tested at 107.4 degrees F. Fire extinguisher was observed and purchased on 2/28/2023. Fire drill last completed on 1/12/24. Outside of facility toured and observed to be free of debris. Carbon monoxide and smoke detectors were tested and observed to be operational. First Aid checked and fully stocked.

A sample of staff and client’s files were reviewed. LPA conducted interviews with staff only. No residents were present during this visit.

No deficiencies issued during this inspection. Exit Interview conducted. The following documents are requested and submitted to Fresno CCL by Administrator. Forms requested: LIC308, LIC 309, LIC 400, LIC 402, LIC 500, LIC 610D, LIC 9282, and control of property will be submitted by 02/02/24. A copy of this report was provided to the Licensee, whose signature on this form confirms receipt of this report.
SUPERVISORS NAME: Sergiy Pidgirny
LICENSING EVALUATOR NAME: Miriam Flores
LICENSING EVALUATOR SIGNATURE: DATE: 01/19/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/19/2024
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 2