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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
157207101
Report Date:
03/28/2022
Date Signed:
03/28/2022 02:13:51 PM
Document Has Been Signed on
03/28/2022 02:13 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:
ALTAVILLE ADULT RESIDENTIAL FACILITY
FACILITY NUMBER:
157207101
ADMINISTRATOR:
NOBLEZA, JOHN & BASILISA
FACILITY TYPE:
735
ADDRESS:
2603 MOUNT VERNON AVENUE
TELEPHONE:
(661) 871-3980
CITY:
BAKERSFIELD
STATE:
CA
ZIP CODE:
93306
CAPACITY:
48
CENSUS:
DATE:
03/28/2022
TYPE OF VISIT:
Case Management - Other
UNANNOUNCED
TIME BEGAN:
12:52 PM
MET WITH:
Nancy Cudal
TIME COMPLETED:
02:23 PM
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I was at the above facility to follow up on complaint 24-AS-20211201134652
. I called and spoke to Administrator, Sally Nobleza on the phone and informed her the purpose of the visit.
SUPERVISOR'S NAME:
Sergiy Pidgirny
TELEPHONE:
(559) 650-7923
LICENSING EVALUATOR NAME:
Les Xiong
TELEPHONE:
(559) 410-1772
LICENSING EVALUATOR SIGNATURE:
DATE:
03/28/2022
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
03/28/2022
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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