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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107206895
Report Date: 12/03/2024
Date Signed: 12/03/2024 03:39:27 PM

Document Has Been Signed on 12/03/2024 03:39 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
SIERRA CASCADE AC/SC, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME:ARC FRESNO/MADERA COUNTIES, KERMAN TRAINING CTR.FACILITY NUMBER:
107206895
ADMINISTRATOR/
DIRECTOR:		THOMPSON-FERNANDEZ,ANDRINAFACILITY TYPE:
775
ADDRESS:14550 W. CALIFORNIA AVENUETELEPHONE:
(559) 547-2692
CITY:KERMANSTATE: CAZIP CODE:
93630
CAPACITY: 100CENSUS: 50DATE:
12/03/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:50 AM
MET WITH:Andrina Thompson-Fernandez, AdministratorTIME VISIT/
INSPECTION COMPLETED:
02:00 PM
NARRATIVE
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On 12/03/24, Licensing Program Analyst (LPA) M. Yang arrived unannounced to conduct an Annual
inspection. LPA introduced self, stated the purpose of the visit and meet with Administrator Andrina Thompson-Fernandez. LPA completed a tour of the facility with Administrator. 24 clients were present during the inspection the activity rooms.

Facility is maintained at a comfortable temperature and no passageway obstructions or fire hazards were observed. Fire extinguishers throughout the facility was observed with served date:12/14/23. Transportation is available and provided for clients. Kitchen was toured. Clients bring their own lunch to program. Client locked lockers were observed throughout activities room. Client restrooms were tour, observed to be clean, and operational. Hot water temperature was 113.6 degrees in front bathroom, 108.4 degrees in bathroom 1, 108.6 degrees in bathroom 2, and 109.9 in bathroom 3. Chemicals and cleaning supplies were observed locked in the chemical supply closet. LPA observed medications in locked case manager’s office. MAR were reviewed. A sample of client and staff files were also reviewed to have the required documents.

A deficiency is being cited on the attached Lic 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:
12/09/24. The following updated forms were requested: Lic 308, Lic 500, Lic 610D, and Lic 9020. A copy of this report and appeal rights was provided to the Administrator, whose signature confirms receipt of this report.
SUPERVISORS NAME: See Moua
LICENSING EVALUATOR NAME: Mai Yang
LICENSING EVALUATOR SIGNATURE: DATE: 12/03/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/03/2024
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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Document Has Been Signed on 12/03/2024 03:39 PM - It Cannot Be Edited


Created By: Mai Yang On 12/03/2024 at 01:10 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: 12/03/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
82087(a)
82087(a)The program site shall be clean, safe, sanitary and in good repair at all times for the safety and well-being of clients, employees and visitors.

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 A1 observed mold in the ice machine which poses a potential health, safety or personal rights risk to person in care.
POC Due Date: 12/04/2024
Plan of Correction
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Ice machine shall be clean and sanitary. Proof of ice machine cleaned and sanitary will be submitted to the Fresno CCL by POC due date 12/04/24.
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:See Moua
LICENSING EVALUATOR NAME:Mai Yang
LICENSING EVALUATOR SIGNATURE:
DATE: 12/03/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 12/03/2024


LIC809 (FAS) - (06/04)
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