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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157206735
Report Date: 09/25/2023
Date Signed: 09/25/2023 02:03:21 PM


Document Has Been Signed on 09/25/2023 02:03 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:RIDGECREST HOME CAREFACILITY NUMBER:
157206735
ADMINISTRATOR:ZAMORA, CRISTINAFACILITY TYPE:
740
ADDRESS:1028 KINNETT AVENUETELEPHONE:
(760) 463-1180
CITY:RIDGECRESTSTATE: CAZIP CODE:
93555
CAPACITY:5CENSUS: 0DATE:
09/25/2023
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME BEGAN:
12:46 PM
MET WITH:Cristina ZamoraTIME COMPLETED:
02:02 PM
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On 9/25/23, Licensing Program Analyst (LPA) M. Medina conducted an unannounced Case Management. LPA contacted Licensee by telephone who arrived a short time later, to conduct visit.

This Department received an e-mail on 9/23/23, indicating that the licensee was unable to renew the lease agreement and would no longer have control of property as of 9/30/23.

LPA toured facility with Licensee and observed to be have very few items remaining, all bedrooms previously occupied by residents were vacant with no personal belongings observed.

LPA retrieved facility license during case management visit and facility closure date will be effective 9/25/23.

No deficiencies cited.
SUPERVISOR'S NAME: Melinda HoffmannTELEPHONE: (559) 341-3247
LICENSING EVALUATOR NAME: Melinda MedinaTELEPHONE: (559) 410-5914
LICENSING EVALUATOR SIGNATURE:
DATE: 09/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/25/2023
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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