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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157209207
Report Date: 02/19/2025
Date Signed: 03/06/2025 07:33:38 AM

Document Has Been Signed on 03/06/2025 07:33 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
FRESNO RO, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME:YOUR LOVED ONES MATTER LLCFACILITY NUMBER:
157209207
ADMINISTRATOR/
DIRECTOR:		JIMENEZ, ISAIFACILITY TYPE:
740
ADDRESS:4804 KENNY STTELEPHONE:
(661) 735-3236
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93307
CAPACITY: 6CENSUS: 6DATE:
02/19/2025
TYPE OF VISIT:Case Management - DeficienciesUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
03:26 PM
MET WITH:Guadalupe Jimenez, StaffTIME VISIT/
INSPECTION COMPLETED:
03:27 PM
NARRATIVE
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On February 19, 2025, Licensing Program Analyst (LPA) Rachel Bruce conducted an unannounced case management visit for the purpose of addressing clearance of staff in the facility. During a recent inspection visit at the facility on February 7, 2025 LPA confirmed that an adult member of the family who turned eighteen on October 18, 2006 had not been finger print cleared to work in the facility.

At today's visit, LPA was provided a copy of the live scan form completed for the adult family member which was completed on February 14, 2025. LPA confirmed that the son is indeed in LIS as cleared and is appropriately associated to the facility. He is now eligible to continue to work at the home.

Deficiency and citation being issued at today's visit.

Technical Advisory: Also during the visit today, LPA and Administrator discussed the fence in the backyard that is in need of repair. Administrator provided information that they are currently working on getting it fixed. LPA explained the need to have it repaired as soon as reasonably possible and to keep LPA appraised on the progress. No citation issued regarding buildings and grounds during today's visit.
SUPERVISORS NAME: Sergiy Pidgirny
LICENSING EVALUATOR NAME: Rachel A Bruce
LICENSING EVALUATOR SIGNATURE: DATE: 02/19/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/19/2025
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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Document Has Been Signed on 03/06/2025 07:33 AM - It Cannot Be Edited


Created By: Rachel A Bruce On 02/19/2025 at 03:27 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: YOUR LOVED ONES MATTER LLC
FACILITY NUMBER: 157209207

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/19/2025
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
02/19/2025
Section Cited
CCR
87355(e)

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Criminal Record Clearance: (e) All individuals subject to a criminal record review ... shall prior to working, residing or volunteering in a licensed facility: (1) Obtain a California clearance or a criminal record exemption as required by the Department. This requirement was not met as evidenced by
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LPA verified that the family member is now finger print cleared and associated to the facility, Your Loved Ones Matter.
POC to be cleared at today's visit.
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Adult family member who turned 18 in October, 2024 was not cleared or associated to the facility at date of visit on February 7, 2025. This poses an immediate threat to the health, safety and/or personal rights of the residents in care.
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Failure to correct the cited deficiency(ies), on or before the Plan of Correction (POC) due date, may result in a civil penalty assessment.
SUPERVISOR'S NAME:Sergiy Pidgirny
LICENSING EVALUATOR NAME:Rachel A Bruce
LICENSING EVALUATOR SIGNATURE:
DATE: 02/19/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/19/2025


LIC809 (FAS) - (06/04)
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