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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157206291
Report Date: 09/20/2021
Date Signed: 09/20/2021 02:31:25 PM

Document Has Been Signed on 09/20/2021 02:31 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:BRIDGE PROGRAM - BAKERSFIELDFACILITY NUMBER:
157206291
ADMINISTRATOR:SANDRA JIMENEZFACILITY TYPE:
772
ADDRESS:6744 EUCALYPTUS DRIVETELEPHONE:
(661) 363-8127
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93306
CAPACITY: 15CENSUS: DATE:
09/20/2021
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
01:17 PM
MET WITH:Deanna BrownTIME COMPLETED:
02:03 PM
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Today, LPA L. Xiong was at the above facility to follow up on an incident occurred on 8/18/21 involving resident R1. I met with Deanna Brown, Program Director. D. Brown informed me R1 was found and currently at Crestwood Psychiatric Hospital Facility (PHF).
SUPERVISORS NAME: Sergiy Pidgirny
LICENSING EVALUATOR NAME: Les Xiong
LICENSING EVALUATOR SIGNATURE: DATE: 09/20/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/20/2021
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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