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

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157208938
Report Date: 05/15/2024
Date Signed: 05/16/2024 08:08:51 AM

Document Has Been Signed on 05/16/2024 08:08 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
FRESNO RO, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME:PURPOSEFUL RESIDENTIAL CARE: ERIE PLACEFACILITY NUMBER:
157208938
ADMINISTRATOR/
DIRECTOR:		VICKERS, TYSONFACILITY TYPE:
735
ADDRESS:1308 ERIE STTELEPHONE:
(661) 742-6007
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93307
CAPACITY: 6CENSUS: 3DATE:
05/15/2024
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
08:32 AM
MET WITH:Neisha Payton, House ManagerTIME VISIT/
INSPECTION COMPLETED:
10:05 AM
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
Licensing Program Analyst Lissett Padgett (LPA) conducted an unannounced health and safety check. Present was two staff, House Manager Niesha Payton (HM) and 3 residents.

LPA toured the facility with HM to ensure the health and safety of the residents in care. LPA inspected the facility with staff including but not limited to the kitchen, resident bedrooms, resident bathroom, living and dining room and the backyard area. LPA reviewed resident files and obtained resident documents.

LPA observed the facility to be free of odor, clean and in good repair. LPA observed that rooms inspected are equipped with the required furniture and there is sufficient lighting throughout the facility. Residents appeared clean and healthy.

LPA observed sufficient seven day non-perishable food stored in the garage shelves. LPA observed sufficient supply of meats and vegetables in the large chest freezer in the garage. LPA observed two day perishable food supply in the refrigerator.

Water in kitchen and bathroom sink are functioning and toilet was flushed and found to be functioning.

Health and Safety check today included the overall safety of the facility including food supply, physical plant and staffing.

No deficiencies were cited pursuant to Title 22 rules and regulations, Health and Safety Codes. Exit interview conducted.
SUPERVISORS NAME: Sergiy Pidgirny
LICENSING EVALUATOR NAME: Lissett Padgett
LICENSING EVALUATOR SIGNATURE: DATE: 05/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/15/2024
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