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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157206776
Report Date: 10/04/2023
Date Signed: 10/06/2023 10:36:28 AM

Document Has Been Signed on 10/06/2023 10:36 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: 3DATE:
10/04/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
11:03 AM
MET WITH:Administrator, Misty Veasey TIME COMPLETED:
11:10 AM
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Licensing Program Analyst (LPA) Darius Williams conducted a facility visit to return Resident 1's file. File was handed to Administrator, Misty Veasey

An exit interview was conducted and a copy of this report will be provided via e-mail.
SUPERVISORS NAME: Serigy Pidgirny
LICENSING EVALUATOR NAME: Darius Williams
LICENSING EVALUATOR SIGNATURE: DATE: 10/04/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/04/2023
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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