<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157208935
Report Date: 08/07/2024
Date Signed: 08/07/2024 02:19:25 PM

Document Has Been Signed on 08/07/2024 02:19 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:TRIUMPH IN THE WESTFACILITY NUMBER:
157208935
ADMINISTRATOR/
DIRECTOR:		CHAVEZ, CARLOSFACILITY TYPE:
737
ADDRESS:8130 NORRIS RDTELEPHONE:
(661) 218-9711
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93312
CAPACITY: 4CENSUS: 4DATE:
08/07/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:30 PM
MET WITH:Carlos Chavez, Jill Bevins
and Agustin Aguilera		TIME VISIT/
INSPECTION COMPLETED:
01:55 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 8/07/2024, Licensing Program Analyst (LPA) M. Medina conducted an unannounced Case Management visit. LPA introduced self and stated purpose of visit. LPA arrived to follow up on a self reported incident that occurred with R1 on 7/09/24 and reported to this department on 7/10/24.

LPA conducted interview and gathered additional information regarding incident.

No deficiencies cited.
SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Melinda Medina
LICENSING EVALUATOR SIGNATURE: DATE: 08/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 08/07/2024
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1