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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157209256
Report Date: 09/21/2023
Date Signed: 09/21/2023 02:02:05 PM

Document Has Been Signed on 09/21/2023 02:02 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: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: 45DATE:
09/21/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
11:41 AM
MET WITH:Administrator Ria Loria and Staff Nancy CudalTIME COMPLETED:
12:30 PM
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Licensing Program Analyst (LPA) Shawna Doucette arrived at the facility unannounced for a complaint investigation. During the course of the investigation, it was found the facility has pests. LPA conducted a case management to address the issue of pests. LPA met with Administrator Ria Loria and Staff Nancy Cudal.


LPA interviewed Staff and Residents. LPA reviewed pest control service records which show the facility was last serviced on 09/15/23 specifically for beds bugs. Facility is following pest control recommendations.


No deficiencies observed.


An exit interview was conducted with Administrator.
SUPERVISORS NAME: Sergiy Pidgirny
LICENSING EVALUATOR NAME: Shawna Doucette
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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