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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157209235
Report Date: 09/21/2023
Date Signed: 09/21/2023 10:53:50 AM

Document Has Been Signed on 09/21/2023 10:53 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:TLC HOME CARE 2FACILITY NUMBER:
157209235
ADMINISTRATOR:ARRIETA JR, RODRIGO A.FACILITY TYPE:
740
ADDRESS:207 RIESLING VINES STTELEPHONE:
(661) 203-7565
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93314
CAPACITY: 6CENSUS: 4DATE:
09/21/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
10:13 AM
MET WITH:Lourdisita VillancioTIME COMPLETED:
11:01 AM
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On 09/21/2023, Licensing Program Analyst (LPA) Walton arrived unannounced to conduct a Case Management inspection. LPA introduced self, stated the purpose of the visit and requested to meet with the Administrator. Facility staff contacted Administrator, Rodrigo Arrieta via telephone.

LPA conducted an interview with Administrator.

No deficiencies issued.

Exit interview conducted. LPA received verbal permission to allow facility staff to sign the report. A copy of this report was discussed and provided to facility staff, Lourdisita Villancio, whos signature on this form confirms receipt of this document.
SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Alexandria Walton
LICENSING EVALUATOR SIGNATURE: DATE: 09/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/21/2023
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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