<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157209256
Report Date: 07/11/2023
Date Signed: 07/11/2023 10:50:12 AM

Document Has Been Signed on 07/11/2023 10:50 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:NOBLEZA, BASILISAFACILITY TYPE:
735
ADDRESS:2603 MOUNT VERNON AVENUETELEPHONE:
(661) 871-3980
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93306
CAPACITY: 54CENSUS: 44DATE:
07/11/2023
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Administrator Basilisa Nobleza, Licensee Representative Christine Juarez and Administrator Ria LoriaTIME COMPLETED:
11:15 AM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Licensing Program Analyst (LPA) Shawna Doucette arrived to the facility announced to conduct the Pre licensing visit. LPA Shawna Doucette met with Administrator Basilisa Nobleza, Licensee Representative Christine Juarez and Administrator Ria Loria who granted LPA's entry into the facility.

LPA toured facility. Common rooms have adequate furnishings and lighting. All of the resident bedrooms have all the required furnishings and adequate lighting. Hot water temperature in bathrooms measured between 106 and 116 degrees F. LPA observed a supply of extra bed linens and personal hygiene and grooming products. Kitchen observed to have dishes, plates, utensils. Cleaning supplies are stored in a locked storage closet. Medications are locked in a medication room. First aid kit contains all the required items. A fire extinguisher is present and has a service date of 08/22/2022. Fire alarm has a complete panel for carbon monoxide and residence has a sprinkler system with pull station fire alarm.

Outside of the facility toured. Exits open free of obstruction. No outside hazards were observed. No pools or bodies of water.

All required postings are posted. Facility phone number will be (661) 871-3980.

Component III was conducted during pre-licensing visit with Applicants.

I have found that applicant has met all pre licensing requirements. LPA will submit documentation to CAB in Sacramento for final review prior to license being issued.
SUPERVISORS NAME: Sergiy Pidgirny
LICENSING EVALUATOR NAME: Shawna Doucette
LICENSING EVALUATOR SIGNATURE: DATE: 07/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/11/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1