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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157206916
Report Date: 12/14/2023
Date Signed: 12/14/2023 02:55:08 PM

Document Has Been Signed on 12/14/2023 02:55 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:VILLAGE GARDENSFACILITY NUMBER:
157206916
ADMINISTRATOR:DIANNA L ELLISFACILITY TYPE:
740
ADDRESS:11910 CROCKETT COURTTELEPHONE:
(661) 587-1191
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93312
CAPACITY: 6CENSUS: 5DATE:
12/14/2023
TYPE OF VISIT:Case Management - Health ChecksUNANNOUNCEDTIME BEGAN:
01:15 PM
MET WITH:Diana Ellis
Margaret Gardea 		TIME COMPLETED:
02:24 PM
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On 12/14/23, Licensing Program Analysts (LPA) M. Medina conducted a Case Management visit. LPA introduced self, stated purpose of visit and allowed entrance by Direct Care Staff.

Direct Staff contacted Margaret Gardea and Diana Ellis by telephone who arrived a short time later. Licensee, Linda Boden contacted by telephone but did not answer.

Facility tour conducted. Currently five residents in care. There are no residents on hospice, and one resident is currently receiving home health services.

Outside of facility toured. Pool is surrounded by fence and observed to be locked and secured. All exits open free of obstruction. No hazards observed.

No deficiencies observed or cited during visit.
SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Melinda Medina
LICENSING EVALUATOR SIGNATURE: DATE: 12/14/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/14/2023
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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