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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107206895
Report Date: 01/25/2023
Date Signed: 01/25/2023 12:54:30 PM

Document Has Been Signed on 01/25/2023 12:54 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:ARC FRESNO/MADERA COUNTIES, KERMAN TRAINING CTR.FACILITY NUMBER:
107206895
ADMINISTRATOR:CHAD FUGATEFACILITY TYPE:
775
ADDRESS:14550 W. CALIFORNIA AVENUETELEPHONE:
(559) 846-8003
CITY:KERMANSTATE: CAZIP CODE:
93630
CAPACITY: 100CENSUS: 53DATE:
01/25/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
11:46 AM
MET WITH:Jessica Figueroa, Case Manager TIME COMPLETED:
01:00 PM
NARRATIVE
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On 01/25/23, Licensing Program Analyst (LPA) M. Yang arrived unannounced to conduct an Annual Inspection - Infection Control. LPA met Jessica Figueroa, Case Manager (CM), stated the purpose of the visit, and requested to meet with Administrator. CM stated Administrator is out of the office and unavailable for meeting for the week. 31 clients were present during the inspection. LPA completed a tour of the facility with CM.

Visitor log-in/temperature check was observed upon entry. Hand sanitizer was readily available to clients and visitors. Social distancing is maintained in the common areas. Facility is maintained at a comfortable temperature and no passageway obstructions or fire hazards were observed inside or outside. COVID-19 related signs observed throughout the facility. LPA observed locked medications in CM’s office. Fire extinguisher serviced date: 12/05/22.

The Day Program has three classrooms separated into cohort for activities. Kitchen was toured. Clients bring their own lunch to program. Client locked lockers were observed in two activities room. LPA observed 30-day PPE supply. Client restrooms were tour, observed to be clean, and operational. LPA observed hand washing posting by all sinks. At 12:20 PM, LPA and CM observed cleaning chemicals stored in Cleaning supply room unlock.

A deficiency is being cited on the attached 809D in accordance to California Code of Regulations, Title 22, Division 6.

Exit Interview conducted. The following documents are requested and to be submitted to Fresno CCL by: 02/01/23. The following updated forms were requested: Lic 308, Lic 500, Lic 610D, and Lic 9282. A copy of this report and appeal rights was provided to CM.

SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Mai Yang
LICENSING EVALUATOR SIGNATURE: DATE: 01/25/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/25/2023
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 01/25/2023 12:54 PM - It Cannot Be Edited


Created By: Mai Yang On 01/25/2023 at 12:34 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: ARC FRESNO/MADERA COUNTIES, KERMAN TRAINING CTR.
FACILITY NUMBER: 107206895

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/25/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
82087(a)(3)
Disinfectants, cleaning solutions, poisons, and other items which could pose a danger if readily available to clients shall be stored where inaccessible to clients.


This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above when LPA and CM observed cleaning chemicals unlocked in facility Cleaning Supply room accessible to clients in care this poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 01/26/2023
Plan of Correction
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CM immediately locked the Chemical Supply room. POC cleared during visit
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Melinda Hoffmann
LICENSING EVALUATOR NAME:Mai Yang
LICENSING EVALUATOR SIGNATURE:
DATE: 01/25/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/25/2023


LIC809 (FAS) - (06/04)
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