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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157206291
Report Date: 08/24/2023
Date Signed: 08/24/2023 11:03:11 AM

Document Has Been Signed on 08/24/2023 11:03 AM - 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:DEANNA BROWNFACILITY TYPE:
772
ADDRESS:6744 EUCALYPTUS DRIVETELEPHONE:
(661) 363-8127
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93306
CAPACITY: 15CENSUS: 15DATE:
08/24/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
10:45 AM
MET WITH:Administrator Deanna BrownTIME COMPLETED:
11:15 AM
NARRATIVE
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Licensing Program Analyst (LPA) Shawna Doucette arrvied at the facility unannounced to conduct a case management for an incident that occurred on 8/17/23.

LPA reviewed resident records. LIC602 states resident can leave facility unsupervised.


No deficiencies

An exit interview was conducted with the Administrator and a copy of this report was provided.
SUPERVISORS NAME: Sergiy Pidgirny
LICENSING EVALUATOR NAME: Shawna Doucette
LICENSING EVALUATOR SIGNATURE: DATE: 08/24/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/24/2023
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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