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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157206898
Report Date: 02/22/2022
Date Signed: 02/23/2022 09:11:53 AM

Document Has Been Signed on 02/23/2022 09:11 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:SPRUCE GARDENSFACILITY NUMBER:
157206898
ADMINISTRATOR:PONCE, BEATRIZ AFACILITY TYPE:
740
ADDRESS:13303 NANTUCKET PLACETELEPHONE:
(661) 829-2703
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93314
CAPACITY: 6CENSUS: 3DATE:
02/22/2022
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME BEGAN:
02:31 PM
MET WITH:Michelle MaciasTIME COMPLETED:
04:15 PM
NARRATIVE
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Licensing Program Analyst LPA Shawna Doucette responded to the facility for a complaint investigation. During the complaint investigation LPA found there is no Administrator for the facility.

Michelle Macias stated she is the current Administrator. LPA reviewed records and was unable to locate an Administrators Certificate. LPA reviewed the personnel report and found that Michelle Macias is cleared in LIS but not associated to the facility.

Deficiencies are being cited in accordance with the CCR Title 22. See LIC 809D.

An exit interview was conducted with Michelle Macias and a copy of this report with Plans of Corrections and appeal rights was emailed to Michelle Macias.
SUPERVISORS NAME: Sergiy Pidgirny
LICENSING EVALUATOR NAME: Shawna Doucette
LICENSING EVALUATOR SIGNATURE: DATE: 02/22/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/22/2022
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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Document Has Been Signed on 02/23/2022 09:11 AM - It Cannot Be Edited


Created By: Shawna Doucette On 02/22/2022 at 02:45 PM
Link to Parent Document Below:
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1314 E SHAW AVE
FRESNO, CA 93710

FACILITY NAME: SPRUCE GARDENS
FACILITY NUMBER: 157206898

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/22/2022
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
03/24/2022
Section Cited
CCR
87405(a)

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87405 Administrator - Qualifications and Duties (a) All facilities shall have a qualified and currently certified administrator. The licensee and the administrator may be one and the same person. The administrator shall have sufficient freedom from other responsibilities and shall be on the premises a sufficient number of hours to permit adequate attention to the management and administration of the facility as specified in this section. When the administrator is not in the facility, there shall be coverage by a designated substitute who shall have qualifications adequate to be responsible and accountable for management and administration of the facility as specified in this section. The Department may require that the administrator devote additional hours in the facility to fulfill his/her responsibilities when the need for such additional hours is substantiated by written documentation.
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Plan of Correction POC Licensee agrees to find an Administrator submit appropriate documentation to associate the Administrator to the facility by POC due date 3/24/22.

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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Sergiy Pidgirny
LICENSING EVALUATOR NAME:Shawna Doucette
LICENSING EVALUATOR SIGNATURE:
DATE: 02/22/2022
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/22/2022


LIC809 (FAS) - (06/04)
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