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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157206771
Report Date: 11/15/2024
Date Signed: 11/15/2024 03:47:06 PM

Document Has Been Signed on 11/15/2024 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:SAILS APPLETREEFACILITY NUMBER:
157206771
ADMINISTRATOR/
DIRECTOR:		JACQUELINE D. TUCKERFACILITY TYPE:
735
ADDRESS:11611 SAN MINIATO AVETELEPHONE:
(661) 570-3035
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93312
CAPACITY: 5CENSUS: 4DATE:
11/15/2024
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
03:19 PM
MET WITH:Erinique JonesTIME VISIT/
INSPECTION COMPLETED:
04:00 PM
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On 11/15/24, Licensing Program Analyst (LPA) M. Medina conducted an unannounced Case Management visit. LPA introduced self, stated purpose of visit and allowed entrance by direct care staff. District Manager (DM), Erinique Jones contacted by telephone and arrived a short time later to conduct visit with LPA.

The purpose of this visit is to verify that Staff (S1) is not on the property. Per DM, S1 does not work at the facility. DM understands that S1 is Excluded and not permitted to be on the grounds at any time.

District Manager stated S1 was disassociated from facility on 9/15/24.

There were no citations issued. An exit interview was conducted and a copy of this report was left with DM, whose signature confirms receipt.
SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Melinda Medina
LICENSING EVALUATOR SIGNATURE: DATE: 11/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/15/2024
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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