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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157206616
Report Date: 08/07/2024
Date Signed: 08/07/2024 03:47:54 PM

Document Has Been Signed on 08/07/2024 03:47 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:ST. THERESE ADULT RESIDENTIAL FACILITYFACILITY NUMBER:
157206616
ADMINISTRATOR/
DIRECTOR:		CASTILLO, MYRA CELESTEFACILITY TYPE:
735
ADDRESS:6909 COPPER CREEK WAYTELEPHONE:
(661) 589-6804
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93308
CAPACITY: 2CENSUS: 2DATE:
08/07/2024
TYPE OF VISIT:Case Management - Annual ContinuationUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
02:38 PM
MET WITH:Myra Celeste Castillo
Hilda Garces		TIME VISIT/
INSPECTION COMPLETED:
04:10 PM
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On 8/07/24, Licensing Program Analyst (LPA) M Medina arrived unannounced to Case Management Annual Continuation. LPA met with Myra Celeste Castillo and stated purpose of visit.

LPA Medina completed inspection tool and reviewed a sample of staff files.

LPA Medina conducted physical plant tour during initial inspection on 7/25/24 and documented on original report.

Exit interview conducted.

No deficiencies cited.
SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Melinda Medina
LICENSING EVALUATOR SIGNATURE: DATE: 08/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/07/2024
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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