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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157206907
Report Date: 10/27/2023
Date Signed: 10/30/2023 10:51:32 AM

Document Has Been Signed on 10/30/2023 10:51 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:UNION VILLAFACILITY NUMBER:
157206907
ADMINISTRATOR:MONTIANO, NANCYFACILITY TYPE:
735
ADDRESS:1102 S. UNION AVE.TELEPHONE:
(661) 323-0768
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93307
CAPACITY: 89CENSUS: 64DATE:
10/27/2023
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
09:10 AM
MET WITH:Staff, Yvonne AggasidTIME COMPLETED:
09:40 AM
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Licensing Program Analyst (LPA) Darius Williams conducted a plan of correction visit. LPA met with Staff, Yvonne Aggasid and discussed the purpose of the visit.

LPA checked water temperature which reflected approximately 119 degrees Fahreinheit (F). Window and sheet rock near kitchen was repaired. The barbwire fencing and tools were removed. The showers were cleaned and LPA will have conversation with Administrator regarding other possible solutions for the showers.

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: 10/27/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/27/2023
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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