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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 150405403
Report Date: 11/09/2021
Date Signed: 11/09/2021 08:57:30 AM

Document Has Been Signed on 11/09/2021 08:57 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, 1310 E. SHAW AVE,
FRESNO, CA 93710
FACILITY NAME:BAKERSFIELD ADULT SCHOOL CHILDREN'S CENTERFACILITY NUMBER:
150405403
ADMINISTRATOR:BARNETT, STACYFACILITY TYPE:
850
ADDRESS:501 S. MT. VERNON AVENUETELEPHONE:
(661) 832-6642
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93307
CAPACITY: 45TOTAL ENROLLED CHILDREN: 45CENSUS: 23DATE:
11/09/2021
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
08:15 AM
MET WITH:Stacy Barnett, DirectorTIME COMPLETED:
09:00 AM
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LPA Pete Espinoza conducted a Case Management visit for the purpose of obtaining signatures and delivery of amended report that supersedes the Complaint Investigation Report and citation issued on 10/28/2021. LPA Met with Stacy Barnett, Director. LPA informed Director the reason for visit and toured the facility both inside and outside as shown on facility sketch. Census was taken.

NO DEFICIENCIES OBSERVED IN THE AREAS INSPECTED DURING TODAY’S VISIT.

LIC 9213 NOTICE OF SITE VISIT FORM IS REQUIRED TO BE POSTED FOR 30 DAYS.

To order forms, etc. visit our website at www.ccld.ca.gov.
SUPERVISORS NAME: Diana deLeon
LICENSING EVALUATOR NAME: Peter Espinoza
LICENSING EVALUATOR SIGNATURE: DATE: 11/09/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/09/2021
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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