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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 502701087
Report Date: 12/21/2022
Date Signed: 01/17/2023 04:34:35 PM

Document Has Been Signed on 01/17/2023 04:34 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, 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: 6DATE:
12/21/2022
TYPE OF VISIT:POCUNANNOUNCEDTIME BEGAN:
11:30 AM
MET WITH:Bonaire YepezTIME COMPLETED:
12:30 PM
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Unannounced Plan of Correction visit made out to this facility on 12/21/2022 by Licensing Program Analyst (LPA) Charlie Yang who was met by the facility staff person, Gabriela Chicas, who was briefly interviewed. This LPA requested that the facility staff person go ahead and contact the facility designated Administrator, Bonaire Yepez, to inform her that CCL was present at this time. The facility designated Administrator arrived later to this facility while this LPA was conducting this visit.
Current census was 6 residents.

The purpose of this visit was to clear the deficiencies that were cited on the prior annual visit conducted on 10/19/2022.
  • Based on observation, the licensee did not comply with the section cited above since the backyard will need to be cleaned up and the debris/unused items will need to be removed which poses/posed a potential health, safety or personal rights risk to persons in care.

  • Based on observation, the licensee did not comply with the section cited above in that several bedroom and common room window screens were either ripped, torn, or in need of repair which poses/posed a potential health, safety or personal rights risk to persons in care.


A clearance letter was printed and a copy was left at this facility.

There were no deficiencies observed or cited during today's plan of correction visit.

Exit Interview
SUPERVISORS NAME: Stephenie Doub
LICENSING EVALUATOR NAME: Charlie Yang
LICENSING EVALUATOR SIGNATURE: DATE: 12/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/21/2022
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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