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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157206776
Report Date: 06/14/2022
Date Signed: 06/14/2022 10:33:28 AM

Document Has Been Signed on 06/14/2022 10:33 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:EUCALYPTUS HOUSEFACILITY NUMBER:
157206776
ADMINISTRATOR:GREENHALGH, STELLAFACILITY TYPE:
735
ADDRESS:7708 SPROAT WAYTELEPHONE:
(661) 282-5687
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93309
CAPACITY: 5CENSUS: 4DATE:
06/14/2022
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
09:46 AM
MET WITH:Misty Veasey, Co-AdministratorTIME COMPLETED:
10:45 AM
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On 6/14/22 at 9:46 AM, Licensing Program Analyst (LPA) Malia Thao arrived unannounced to conduct a Plan of Correction (POC) inspection. LPA explained reason for inspection and was granted entry by staff. Co-Administrator (ADM) Misty Veasey arrived a short time later.

LPA observed window screen frames repaired or replaced for bedrooms #1 and #2, living room, and office; new window screen installed for bedroom #4; new curtain rods replaced in bedrooms #1 and #2; right side exterior gate repaired and opening/closing with ease; and new pull string and latch installed for left side exit gate and repaired to be opening/closing with ease.

POC cleared. No deficiencies cited during this inspection.

Exit interview conducted. A copy of this report was given to Co-Administrator Misty Veasey, whose signature confirms receipt of this report.
SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Malia Thao
LICENSING EVALUATOR SIGNATURE: DATE: 06/14/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/14/2022
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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