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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157209503
Report Date: 11/07/2024
Date Signed: 11/12/2024 08:41:42 AM

Document Has Been Signed on 11/12/2024 08:41 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:CARING HAVEN ASSISTED LIVING LLCFACILITY NUMBER:
157209503
ADMINISTRATOR/
DIRECTOR:		QUIROZ, JANIE VALERIEFACILITY TYPE:
740
ADDRESS:4613 CHERRYROCK AVETELEPHONE:
(661) 472-7288
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93313
CAPACITY: 6CENSUS: 0DATE:
11/07/2024
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:00 AM
MET WITH:Administrator Janie QuirozTIME VISIT/
INSPECTION COMPLETED:
09:45 AM
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Licensing Program Analyst (LPA) Shawna Doucette arrived at the facility announced to conduct a pre licensing inspection. LPA met with Administrator Janie Quiroz.

LPA was unable to complete the inspection. Licensee did not have plan of operation at the facility or infection control plan for LPA to review. LPA will return at a later date to complete the inspection.

Facility has a spa that will need to be locked.

A copy of the report was provided.
SUPERVISORS NAME: Sergiy Pidgirny
LICENSING EVALUATOR NAME: Shawna Doucette
LICENSING EVALUATOR SIGNATURE: DATE: 11/07/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/07/2024
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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