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Department of
SOCIAL SERVICES
Community Care Licensing
FACILITY EVALUATION REPORT
Facility Number:
157208773
Report Date:
08/19/2023
Date Signed:
08/19/2023 08:33:16 AM
Document Has Been Signed on
08/19/2023 08:33 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:
JASMIN TERRACE AT BAKERSFIELD
FACILITY NUMBER:
157208773
ADMINISTRATOR:
ELECO, RAMONA D.
FACILITY TYPE:
740
ADDRESS:
5400 STINE ROAD
TELEPHONE:
(661) 398-8802
CITY:
BAKERSFIELD
STATE:
CA
ZIP CODE:
93313
CAPACITY:
99
CENSUS:
75
DATE:
08/19/2023
TYPE OF VISIT:
Case Management - Other
UNANNOUNCED
TIME BEGAN:
08:12 AM
MET WITH:
Staff Ariadna Ku
TIME COMPLETED:
08:35 AM
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LPA Shawna Doucette arrived at the facility unannounced to return R1's file. LPA met with Staff Ariadna Ku at the front office.
R1's file was returned.
A copy of this report was provided.
SUPERVISOR'S NAME:
Sergiy Pidgirny
TELEPHONE:
(559) 246-0610
LICENSING EVALUATOR NAME:
Shawna Doucette
TELEPHONE:
(559) 580-4595
LICENSING EVALUATOR SIGNATURE:
DATE:
08/19/2023
I acknowledge receipt of this form and understand my
licensing
appeal rights as
explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE:
08/19/2023
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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