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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 502701087
Report Date: 05/24/2024
Date Signed: 05/24/2024 04:51:33 PM

Document Has Been Signed on 05/24/2024 04:51 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
SACRAMENTO SOUTH ASC, 9835 GOETHE ROAD, SUITE 100
SACRAMENTO, CA 95827
FACILITY NAME:BONNIE'S CARE HOMEFACILITY NUMBER:
502701087
ADMINISTRATOR/
DIRECTOR:		YEPEZ, BONAIREFACILITY TYPE:
740
ADDRESS:2608 VENEMAN AVENUETELEPHONE:
(209) 272-4444
CITY:MODESTOSTATE: CAZIP CODE:
95356
CAPACITY: 6CENSUS: 3DATE:
05/24/2024
TYPE OF VISIT:Case Management - Legal/Non-complianceUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
03:00 PM
MET WITH:Bonaire YepezTIME VISIT/
INSPECTION COMPLETED:
03:30 PM
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An Informal Conference was conducted today, 05/24/24, via Microsoft Teams. The purpose of the Informal Conference was to discuss the facilities non-compliance with Title 22 Regulations. Present at today’s Informal Conference were Licensing Program Manager (LPM) Lisa Rios, Licensing Program Analyst (LPA) Maja Jensen, and Licensee, Bonaire Yepez. The informal conference process was explained during this meeting. The facility has received 2 type A citations and 7 type B citations within the last 10 months.

The Licensee was offered an opportunity to participate in the Department's Technical support Program and accepted. The Licensee indicated that she is in the process of hiring a new Administrator. The Licensee also stated that she is in the process of changing the facility flooring however the renovations are not anticipated to impact clients in care.

The Department will conduct a Health and Safety check in approximately 4-6 months to monitor for compliance. No deficiencies were cited as a result of this meeting.

An exit interview was conducted by telephone and a copy of this report and appeal rights were provided electronically.
SUPERVISORS NAME: Lisa Rios
LICENSING EVALUATOR NAME: Maja Jensen
LICENSING EVALUATOR SIGNATURE: DATE: 05/24/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 05/24/2024
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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