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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 247200745
Report Date: 02/10/2022
Date Signed: 02/10/2022 02:14:07 PM

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:NEW BETHANYFACILITY NUMBER:
247200745
ADMINISTRATOR:FONSECA, JULIAFACILITY TYPE:
740
ADDRESS:1441 BERKELEY DRIVETELEPHONE:
(209) 827-8933
CITY:LOS BANOSSTATE: CAZIP CODE:
93635
CAPACITY:76CENSUS: 45DATE:
02/10/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:Lucinda Fonseca - DirectorTIME COMPLETED:
10:15 AM
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Licensing Program Analyst(LPA) D. Ayers arrived at the facility unannounced to conduct a Required Annual inspection. LPA met with Director Lucinda Fonseca.

LPA toured the facility inside and out. All passageways and exits were clear and free from obstruction. The facility was adequately furnished and at a comfortable temperature. All smoke detectors and the carbon monoxide detector were operational. The outdoor space was free from hazards. LPA observed a two day supply of perishables and a seven day supply of nonperishable food stuffs. Medications were kept in locked rooms in each wing of the facility, and medications appeared to be administered properly. Chemicals and cleaning supplies were kept in a locked utility rooms. Facility had sufficient hygiene items for residents.

LPA reviewed infection control protocols and best practices with Director. No deficiencies cited during the inspection. Exit interview conducted. A copy of the report was provided via email.

SUPERVISOR'S NAME: Andy XiongTELEPHONE: (559) 650-7904
LICENSING EVALUATOR NAME: David AyersTELEPHONE: (559) 650-7925
LICENSING EVALUATOR SIGNATURE:

DATE: 02/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/10/2022
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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