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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 502701087
Report Date: 09/15/2021
Date Signed: 09/15/2021 11:41:10 AM

Document Has Been Signed on 09/15/2021 11:41 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, 2525 NATOMAS PARK DR. STE.270
SACRAMENTO, CA 95833
FACILITY NAME:BONNIE'S CARE HOMEFACILITY NUMBER:
502701087
ADMINISTRATOR:YEPEZ, BONAIREFACILITY TYPE:
740
ADDRESS:2608 VENEMAN AVENUETELEPHONE:
(209) 272-4444
CITY:MODESTOSTATE: CAZIP CODE:
95356
CAPACITY: 6CENSUS: 0DATE:
09/15/2021
TYPE OF VISIT:PrelicensingUNANNOUNCEDTIME BEGAN:
10:30 AM
MET WITH:BONAIRE YEPEZTIME COMPLETED:
11:45 AM
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Licensing Program Analyst Sarah Hurt (LPA) arrived announced to conduct a second Pre Licensing visit on September 15, 2021. LPA met Licensee Bonaire Yepez at the facility. LPA explained the purpose of this visit was to ensure the correction was made on the hot water temperature from the first pre licensing visit. LPA checked hot water several times, and in several different locations in the facility. The water temperature measured to be at 110 degrees in the bathroom sink, and also the kitchen sink.(within the regulations of 105 degrees and 120 degrees).

At this time, facility has met all pre - licensing requirements of Title 22 division 6 of chapter 1.

An exit interview was conducted and a copy of this report was left at the facility.
SUPERVISORS NAME: Stephenie Doub
LICENSING EVALUATOR NAME: Sarah Hurt
LICENSING EVALUATOR SIGNATURE: DATE: 09/15/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/15/2021
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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