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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157208817
Report Date: 06/14/2024
Date Signed: 06/14/2024 01:03:03 PM


Document Has Been Signed on 06/14/2024 01:03 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:BOGGS FACILITYFACILITY NUMBER:
157208817
ADMINISTRATOR:MARCUS HUFFFACILITY TYPE:
740
ADDRESS:810 DARLINGHAM COURTTELEPHONE:
(661) 282-1438
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93312
CAPACITY:4CENSUS: 4DATE:
06/14/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:20 AM
MET WITH:Kelly Wejmar
Sha-Ron Thomas		TIME COMPLETED:
01:26 PM
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On 6/14/24, Licensing Program Analyst (LPA) M. Medina conducted an unannounced Annual Required Inspection. LPA arrived, introduced self, stated purpose of visit and allowed entrance by House Manager, Kelly Wejmar. Also present was Sha-Ron Thomas.

Facility currently, has four (4) residents in placement. Two residents were present at start of inspection and two residents were at day program. Residents attend day program Monday through Friday 8:00AM to 3:00 PM. At start of inspection, one resident observed to relaxing in the living room and one resident in the bedroom watching television.

Facility tour conducted with both house managers, LPA observed to be clean, well lit, and a comfortable temperature. All residents bedrooms toured, all bedrooms observed to have required furnishings available. Resident bathrooms toured, LPA observed both toilet and shower areas to have grab bars, shower is also equipped with a non-skid surface. Water temperature measured at 108 degrees F at time of inspection. All common areas of facility have adequate seating available for residents in care. Kitchen toured, facility observed to have adequate food supply for residents in care, knives observed to be secured in locked medication closet. Medications also observed to be secured in locked medication closet. Medications observed to have original labels and to be administered as prescribed by physician. All chemicals and cleaning supplies observed to be secured in locked laundry room. Smoke detectors and carbon monoxide detectors present and observed operational. Fire extinguisher present with a purchase date of 8/5/2023. Las fire drill conducted 6/11/24 according to facility records,
SUPERVISOR'S NAME: Melinda HoffmannTELEPHONE: (559) 341-3247
LICENSING EVALUATOR NAME: Melinda MedinaTELEPHONE: (559) 410-5914
LICENSING EVALUATOR SIGNATURE:
DATE: 06/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/14/2024
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME: BOGGS FACILITY
FACILITY NUMBER: 157208817
VISIT DATE: 06/14/2024
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Outside of facility observed to have a covered seating area for residents. No hazards observed.

Staff and resident files reviewed.

LPA requested the following documents to be submitted to Fresno Regional Office no later than 6/28/24: LIC 308 (Designation of Administrative Responsibility), LIC 309 (Administrative Organization), LIC 500 (Personnel Roster), LIC 9020 (Register of Facility Clients/Residents), Copy of Liability Insurance.

No deficiencies cited during inspection

Exit interview conducted.
SUPERVISOR'S NAME: Melinda HoffmannTELEPHONE: (559) 341-3247
LICENSING EVALUATOR NAME: Melinda MedinaTELEPHONE: (559) 410-5914
LICENSING EVALUATOR SIGNATURE:

DATE: 06/14/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 06/14/2024
LIC809 (FAS) - (06/04)
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