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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157209207
Report Date: 05/15/2024
Date Signed: 05/15/2024 02:40:54 PM


Document Has Been Signed on 05/15/2024 02:40 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
FRESNO RO, 1314 E SHAW AVE
FRESNO, CA 93710



FACILITY NAME:YOUR LOVED ONES MATTER LLCFACILITY NUMBER:
157209207
ADMINISTRATOR:JIMENEZ, ISAIFACILITY TYPE:
740
ADDRESS:4804 KENNY STTELEPHONE:
(661) 491-3782
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93307
CAPACITY:6CENSUS: DATE:
05/15/2024
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
10:53 AM
MET WITH:Guadalupe Jimenez, Care giverTIME COMPLETED:
11:40 AM
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Licensing Program Analyst Lissett Padgett (LPA) conducted an unannounced POC visit with facility care giver Guadalupe Jimenez to verify correction of citations issued during the visit conducted on 4/25/2024. Licensee Isai Jimenez was called but was not able to arrive. Licensee gave permission for Guadalupe to sign this LIC809 .

Deficiency cited on 4/25/2024,87303(a) The facility shall be clean, safe, sanitary and in good repair at all times. Maintenance shall include provision of maintenance services and procedures for the safety and well-being of residents, employees and visitors. LPA observed shower has cleaned, patio has been cleared of chicken feces. The glass shards have been cleaned and replacement has been ordered and will be installed today. Guadalupe showed this LPA verification from window installer of appointment scheduled for today.

Deficiency 87303(c) All window screens shall be clean and maintained in good repair. LPA observed that the window screen has been replaced.


Exit interview conducted with Guadalupe Jimenez and a copy of this report was left at the facility.
SUPERVISOR'S NAME: Sergiy PidgirnyTELEPHONE: (559) 246-0610
LICENSING EVALUATOR NAME: Lissett PadgettTELEPHONE: (559) 243-8080
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)
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