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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157209256
Report Date: 10/12/2024
Date Signed: 10/12/2024 10:56:31 AM

Document Has Been Signed on 10/12/2024 10:56 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:VERNON GARDENS RESIDENTIAL CARE CENTERFACILITY NUMBER:
157209256
ADMINISTRATOR/
DIRECTOR:		CUDAL, NANCYFACILITY TYPE:
735
ADDRESS:2603 MOUNT VERNON AVENUETELEPHONE:
(661) 374-8969
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93306
CAPACITY: 54CENSUS: 47DATE:
10/12/2024
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:04 AM
MET WITH:Administrator Nancy CudalTIME VISIT/
INSPECTION COMPLETED:
11:00 AM
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LPA Shawna Doucette arrived at the facility unannounced to conduct a Case Management Health and Safety Check due to reports of facility utility notices for shut off at one of Licensee's facilities.

LPA requested copies of utility bills (water, garbage, electric, gas, phone) for July 2024, August 2024, September 2024 and October 2024 (or most current) submitted by 10/15/2024. LPA toured the facility and observed the power to be on and water was running. The facility was set at a comfortable temperature.


A copy of this report was provided to Administrator.
SUPERVISORS NAME: Sergiy Pidgirny
LICENSING EVALUATOR NAME: Shawna Doucette
LICENSING EVALUATOR SIGNATURE: DATE: 10/12/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/12/2024
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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