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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157209146
Report Date: 04/30/2024
Date Signed: 04/30/2024 11:29:27 AM


Document Has Been Signed on 04/30/2024 11:29 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:QUALITY CARE ASSISTED LIVINGFACILITY NUMBER:
157209146
ADMINISTRATOR:ESPINAL, ALMAFACILITY TYPE:
740
ADDRESS:2607 MT. VERNON AVENUETELEPHONE:
(661) 871-8133
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93306
CAPACITY:54CENSUS: DATE:
04/30/2024
TYPE OF VISIT:OfficeUNANNOUNCEDTIME BEGAN:
10:40 AM
MET WITH:Licensee Representative Krinstine Juarez, Administrator Ria Loria, Operations Manager Nieva RuizTIME COMPLETED:
11:45 AM
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An informal meeting was held on 04/30/2024 at the Fresno Regional Office. The purpose of the informal meeting was to discuss recently identified issues/concerns associated with the operation of the facility. The informal meeting process was explained during this meeting.

The following were in attendance:
Kristine Juarez, Licensee Representative
Ria Loria, Administrator
Nieva Ruiz, Operations Manager
Sergiy Pidgirny, Licensing Program Manager
Shawna Doucette, Licensing Program Analyst

The following concerns were addressed:
Responsibility of Licensing Governing Body, Administrator Qualifications and Duties, Care and Supervision, Medications, Food, and Reporting Requirements.
TSP was offered to Licensee.
Licensee was provided with copies of all applicable regulations and/or Health and Safety Code and a copy of this report.
SUPERVISOR'S NAME: Sergiy PidgirnyTELEPHONE: (559) 246-0610
LICENSING EVALUATOR NAME: Shawna DoucetteTELEPHONE: (559) 580-4595
LICENSING EVALUATOR SIGNATURE:
DATE: 04/30/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/30/2024
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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