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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
157206291
Report Date:
09/13/2022
Date Signed:
09/13/2022 03:48:28 PM
Document Has Been Signed on
09/13/2022 03:48 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 - BAKERSFIELD
FACILITY NUMBER:
157206291
ADMINISTRATOR:
DEANNA BROWN
FACILITY TYPE:
772
ADDRESS:
6744 EUCALYPTUS DRIVE
TELEPHONE:
(661) 363-8127
CITY:
BAKERSFIELD
STATE:
CA
ZIP CODE:
93306
CAPACITY:
15
CENSUS:
DATE:
09/13/2022
TYPE OF VISIT:
Case Management - Other
UNANNOUNCED
TIME BEGAN:
04:08 PM
MET WITH:
Venesta Grinnage
TIME COMPLETED:
04:54 PM
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Licensing Program Analyst (LPA) Les Xiong conducted a case management visit to the facility to complete an annual inspection conducted on 9/12/22.
SUPERVISORS NAME
:
Sergiy Pidgirny
LICENSING EVALUATOR NAME
:
Les Xiong
LICENSING EVALUATOR SIGNATURE
:
DATE:
09/13/2022
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
09/13/2022
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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