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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157209151
Report Date: 06/29/2022
Date Signed: 06/29/2022 01:41:41 PM

Document Has Been Signed on 06/29/2022 01:41 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:CHARTER OAKS SOUTHWEST LLCFACILITY NUMBER:
157209151
ADMINISTRATOR:CLEMENTE, LOUIEFACILITY TYPE:
735
ADDRESS:3501 SELIGMAN DRIVETELEPHONE:
(661) 836-9829
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93309
CAPACITY: 6CENSUS: 5DATE:
06/29/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
11:38 AM
MET WITH:Louie Clemente, Administrator
Robert Clemente, Co-Administrator		TIME COMPLETED:
02:00 PM
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On 6/29/22 at 11:38 AM, Licensing Program Analyst (LPA) Malia Thao arrived unannounced to conduct a case management - incident inspection. LPA explained reason for inspection and was granted entry. Administrator (ADM) Louie Clemente and Co-Administrator Robert Clemente arrived a short time later.

On 6/10/22, CCL received a faxed special incident report (SIR) about R1's AWOL from the facility on 6/8/22. The SIR indicated R1 signed out of the facility on 6/8/22 and did not return by dinner as promised by R1. Facility called the local law enforcement, Bakersfield PD, at 8:15 PM to report R1 as having not returned to the facility. On 6/9/22, Bakersfield PD identified R1 as a missing person. Facility indicated on the SIR that R1 returned to the facility on 6/10/22 at 10 AM.

LPA reviewed R1's records and interviewed ADM.

No deficiencies cited during this inspection.

Exit interview conducted. A copy of this report was given to Administrator Louie Clemente, whose signature confirms receipt of this report.
SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Malia Thao
LICENSING EVALUATOR SIGNATURE: DATE: 06/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/29/2022
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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