157209538-5-20-2026-24-AS-MVEA-DU9VS3-20260520164053

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 157209538
Report Date: 05/20/2026
Date Signed: 05/20/2026 04:41:04 PM

Document Has Been Signed on 05/20/2026 04:41 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
FRESNO RO, 1314 E SHAW AVE
FRESNO, CA 93710

FACILITY NAME:	WAY MAKER HOME CARE 2 LLC		FACILITY NUMBER:	157209538
ADMINISTRATOR/ DIRECTOR:	OGLETREE, WINIGELDA		FACILITY TYPE:	740
ADDRESS:	5816 EMPRESS TREE DR.		TELEPHONE:	(661) 498-7679
CITY:	BAKERSFIELD	STATE: CA	ZIP CODE:	93313
CAPACITY: 6		CENSUS: 5	DATE:	05/20/2026
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME VISIT/ INSPECTION BEGAN:	01:30 PM
MET WITH:	Administrator - Marie Sydel G Lopez		TIME VISIT/ INSPECTION COMPLETED:	05:30 PM

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On 05/20/2026, Licensing Program Analyst (LPA) M Vega arrived at the facility to conduct an Annual Inspection. LPA was granted entry into facility by staff. LPA met with Administrator (AD) - Marie Sydel G Lopez.

Emergency Disaster and Infection Control Plans were reviewed. Staff files and Resident Files reviewed. Paperwork to be accurate at time of inspection.

LPA began the tour of the 4 bedroom, 2 bathroom, single story home. Required postings were observed properly hung in the living area. Common areas throughout the home were well lit with functioning ceiling fans and clear walkways. Doorways have functioning door chimes. Furniture was observed to be properly spaced and in good condition. Flooring is intact throughout the home. LPA observed supply of paper products, bed linens, towels and personal hygiene/grooming products.

Rooms are set up with all required furniture, bedding and storage space. Both bathrooms are clean, in good repair with faucets delivering hot water at 111.0 degrees Fahrenheit. 1 room is designated and set up as an office.

The kitchen was observed to have a supply of dishes, plates, utensils, and cooking items. Cleaning supplies and chemicals are stored and locked in a cabinet under the kitchen sink. Sharps/knives were secured in a kitchen drawer. Appliances were found to be in working order. LPA observed the required food supply, including separate emergency food, water and supplies. Resident medications will be stored in a locking kitchen cabinet. The First aid kits contained the required items. Doors and passageways are unobstructed throughout the inside of the home.

Continuation on LIC 809C

NAME OF LICENSING PROGRAM MANAGER: Shawna Doucette
NAME OF LICENSING PROGRAM ANALYST: Martin Vega
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 05/20/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/20/2026

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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California Health & Human Services Agency

California Department of Social Services

FACILITY EVALUATION REPORT California law requires a public report of each licensing visit/inspection. This report is a record for the facility and the licensing agency. This report is available for public review; therefore, care is taken not to disclose personal or confidential information. Inquiries concerning the location, maintenance, and contents of these reports may be directed to the Licensing Program Analyst or Regional Office whose address and telephone number are listed on the front of this form.

DEFICIENCIES A deficiency is an instance of noncompliance with licensing requirements, including applicable statutes, regulations, interim licensing standards, operating standards, and written directives. Applicants/ licensees must be notified in writing of all licensing deficiencies. Deficiencies are listed on the left side of this form, and the applicable licensing requirement upon which the deficiency is identified. There are two types of deficiencies:

Type A deficiencies are violations of licensing requirements that, if not corrected, have a direct and immediate risk to the health, safety, or personal rights of persons in care.

Type B deficiencies are violations of licensing requirements that, without correction, could become a risk to the health, safety, or personal rights of persons in care, a recordkeeping violation that could impact the care of said persons and/or protection of their resources, or a violation that could impact those services required to meet the needs of persons in care.

PLANS OF CORRECTION (POCs) The licensing agency is required to establish a reasonable length of time to correct a deficiency. In order to set the time, the licensing agency must take into consideration the seriousness of the violation, the number of persons in care involved, and the availability of equipment and personnel necessary to correct the violation. Applicants/licensees are requested to provide a specific plan for each violation on the right side of the form across from each deficiency. The more specific the plan, the less chance exists for any misunderstanding in setting time limits and reviewing corrections. The applicant/licensee who encounters problems beyond their control in completing the corrections within the specified time frame may request and may be granted an extension of the correction due date by the licensing agency.

CORRECTION NOTIFICATION The applicant/licensee is responsible for completing all corrections and promptly notifying the licensing agency of corrections. Applicants/licensees are advised to keep a dated copy of any correspondence sent to the licensing agency concerning corrections, or if corrections are telephoned to the licensing agency, the date, person contacted, and information given.

CIVIL PENALTIES The licensing agency is required by law to issue a Penalty Notice, when applicable, to all facilities holding a license issued by the licensing agency, or subject to licensure, except Certified Family Homes, Resource Families, and Foster Family Homes, or any governmental entity.

PENALTY NOTICE GIVEN The statement concerning civil penalties serves as a penalty notice on this Licensing Report and failure to correct cited licensing deficiencies will result in civil penalties. Applicants/ licensees are required to pay civil penalties when administrative appeals have been exhausted and in accordance with any payment arrangements made with the licensing agency.

APPEAL RIGHTS The applicant/licensee has a right without prejudice to discuss any disagreement in this report with the licensing agency concerning the proper application of licensing requirements. The applicant/ licensee may request a formal review by the licensing agency to amend or dismiss the notice of deficiency and/ or civil penalty. Requests for review shall be made in writing within 15 business days of receipt of a deficiency notification or civil penalty assessment. Licensing deficiencies may be appealed pursuant to the procedures in the LIC 9058 Applicant/Licensee Rights.

AGENCY REVIEW The licensing agency review of an appeal may be conducted based upon information provided in writing by the applicant/licensee. The applicant/licensee may request an office meeting to provide additional information. The applicant/licensee will be notified in writing of the results of the agency review within 60 business days of the date when all necessary information has been provided to the licensing agency.

EMAIL REQUIREMENT Adult Community Care Facilities, Residential Care Facilities for the Chronically Ill, and Residential Care Facilities for the Elderly are required to provide and maintain an active email address of record with the licensing agency.

LIC809 (FAS) - (09/23)

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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
FRESNO RO, 1314 E SHAW AVE
FRESNO, CA 93710

FACILITY NAME: WAY MAKER HOME CARE 2 LLC	FACILITY NUMBER: 157209538
	VISIT DATE: 05/20/2026

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Smoke and Carbon Monoxide detectors were tested and found to be in working order. The Fire Extinguishers were serviced 05/01/2026.

Outside of the facility was toured. There is outdoor seating area and a self-releasing gate found to be working properly. Walkways in front and backyards are clear.

Based on the LPA's observation, California Code of Regulations, Title 22, Division 6, was not met. Deficiencies are being cited on the attached LIC 809-D.

Community Care Licensing (CCL) is always striving to have facility files that reflect the most accurate and up to date information for your facility. In an effort to maintain your facility file, please submit the most current and complete forms and/or information as identified below:

Residential Care Facility for the Elderly (RCFE)

LIC 308 Designation of Facility Responsibility

LIC 309 Administrative Organization

LIC 400 Affidavit Regarding Client/Resident Cash Resources

LIC 402 Surety Bond

LIC 500 Personnel Report

LIC 610E Emergency And Disaster Plan For Residential Care Facilities For The Elderly

LIC 9020 Register of Facility Clients/Residents

Copy of current Liability Insurance

Copy of current Administrator Certificate

Alternate contact information including name, telephone number, & email address.

Please submit the above forms/information to Fresno CCL by: 06/03/2026 As an operator of a Community Care Licensed facility it is your responsibility to be aware of and in compliance with all regulations, including Chaptered Legislation. Go to www.ccld.ca.gov to stay updated and informed.

Exit interview conducted. This report was signed, and a copy of this report was provided to Administrator for facility records.

NAME OF LICENSING PROGRAM MANAGER: Shawna Doucette
NAME OF LICENSING PROGRAM ANALYST: Martin Vega
LICENSING PROGRAM ANALYST SIGNATURE:	DATE: 05/20/2026

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/20/2026

LIC809 (FAS) - (06/04)

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Document Has Been Signed on 05/20/2026 04:41 PM - It Cannot Be Edited

Created By: Martin Vega On 05/20/2026 at 04:14 PM

Link to Parent Document Below:

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
, 1314 E SHAW AVE
FRESNO, CA 93710

FACILITY NAME: WAY MAKER HOME CARE 2 LLC	FACILITY NUMBER: 157209538
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 05/20/2026

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

87555(b)(28)

General Food Service Requirements

(28) All food shall be protected against contamination. Contaminated food shall be discarded immediately upon discovery. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation in refrigerator and pantry, the licensee/administrator did not comply with the section cited above in 6 out of 6 instances of spoiled food and unknown food items, food not in proper container or broken container, which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 06/03/2026
	Plan of Correction
1 2 3 4	Ensure Dates and lables are placed on opened food items. Administrator will provide training to staff and submit training to LPA.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.

	Shawna Doucette
NAME OF LICENSING PROGRAM MANAGER:

	Martin Vega
NAME OF LICENSING PROGRAM ANALYST:

LICENSING PROGRAM ANALYST SIGNATURE:

DATE: 05/20/2026

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 05/20/2026

LIC809 (FAS) - (06/04)

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