<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157209292
Report Date: 03/28/2023
Date Signed: 03/28/2023 12:09:42 PM

Document Has Been Signed on 03/28/2023 12:09 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:CAMILA CARE VILLA IIFACILITY NUMBER:
157209292
ADMINISTRATOR:PANGILINAN, MARIA EMMAFACILITY TYPE:
740
ADDRESS:816 LOCH LLOYD LANETELEPHONE:
(904) 762-5945
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93312
CAPACITY: 6CENSUS: 6DATE:
03/28/2023
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
08:55 AM
MET WITH:Maria Emma PangilnanTIME COMPLETED:
12:15 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 03/28/23, Licensing Program Analyst (LPA) M. Medina conducted an announced Pre-licensing inspection. LPA introduced self, stated the purpose of the visit, and was granted entry into the facility. LPA met with Licensee Maria Emma Pangilnan. LPA toured the facility with Licensee.

This facility location is currently licensed with 6 residents in placement. All residents were present during today's inspection.

The facility is 5 bedrooms and 2 bathrooms home. Fire clearance was granted for 5 non-ambulatory and 1 bedridden resident. Common areas were furnished and had adequate seating and lighting available. All bedrooms were observed to have required furnishings. Kitchen was toured and observed to have dishes, plate, and utensils. Facility has 7-day supply of non-perishable food available as of date of inspection. Knives were observed to be locked and secured in kitchen drawer. Medications will be kept in locked closet. First aid kit was observed in kitchen with all required regulation items. Cleaning supplies and chemicals were observed to be in a locked cabinet in the laundry room. Fire extinguisher present with a service date of 8/23/22. Smoke detector and carbon monoxide detectors were observed operational during this inspection. All exits have auditory alarms in place and observed operational.

Outside of facility toured. Exits were open and free of obstructions.

Component III was conducted during today's pre-licensing visit.

LPA has found that the applicant has met all pre-licensing requirements. LPA will submit documentation to CAB in Sacramento for final review prior to license being issued.

SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Melinda Medina
LICENSING EVALUATOR SIGNATURE: DATE: 03/28/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/28/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1