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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107207171
Report Date: 06/05/2024
Date Signed: 07/02/2024 09:11:58 AM

Document Has Been Signed on 07/02/2024 09:11 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
SIERRA CASCADE AC/SC, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME:ARC FRESNO/MADERA COUNTIES, REEDLEY TRAINING CTRFACILITY NUMBER:
107207171
ADMINISTRATOR/
DIRECTOR:		WHEELER, KELLYFACILITY TYPE:
775
ADDRESS:1613 12TH STREETTELEPHONE:
(559) 638-5959
CITY:REEDLEYSTATE: CAZIP CODE:
93654
CAPACITY: 45CENSUS: 63DATE:
06/05/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
01:57 PM
MET WITH:Program Manager, Kelly WheelerTIME VISIT/
INSPECTION COMPLETED:
04:13 PM
NARRATIVE
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On 5/12/23 Licensing Program Analyst (LPA) M. Garza arrived unannounced for an annual inspection visit. LPA was met by Program Manager, Kelly Wheeler and Case Manager, Robert Perez. LPA introduced self, explained reason for visit and was permitted entry into the facility.

LPA completed a health and safety check on residents in care. LPA toured the facility inside and out. Residents observed in common areas. Pathways and doors were clear and free from obstruction. Facility was clean, without odor, adequately furnished, and adequately lit. Smoke detectors and carbon monoxide detectors were present and operate on a system. Fire extinguisher last serviced 1/22/24. Last fire drill on 1/2/24. Medications kept in locked office inside lock box.

LPA requested the following documents to be submitted to CCL by 6/12/24: current copy of Administrator Organization (LIC 309), Designation of Administrative Responsibility (LIC 308), Emergency Disaster Plan (LIC 610-D), Affidavit regarding Resident Cash Resources (LIC 400), Personnel Report (LIC 500), Register of Facility Clients/Residents (LIC 9020) in order to update the facility file.

During the visit the following issues were observed. Water temperature in kitchen and activities room measured over 125 degrees F requiring a warning sign. Chemicals/items that could pose a danger to clients unlocked and accessible to clients in care. Disaster plan present but in need of additional details. Deficiencies were cited during inspection per Title 22 and TV was provided. Exit interview completed with Case Manager, Robert.

A copy of this report, TV, deficiencies and appeal rights provided.

SUPERVISORS NAME: See Moua
LICENSING EVALUATOR NAME: Mary Garza
LICENSING EVALUATOR SIGNATURE: DATE: 06/05/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 06/05/2024
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 07/02/2024 09:11 AM - It Cannot Be Edited


Created By: Mary Garza On 06/05/2024 at 03:33 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, REEDLEY TRAINING CTR
FACILITY NUMBER: 107207171

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 06/05/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
82087(a)(3)
Buildings and Grounds
(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. (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 LPA observation, the licensee did not comply with the section cited above in that chemicals/items that could pose a danger to clients in care were unlocked and accessible to clients in the activity closet and activity rooms (2). This poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/14/2024
Plan of Correction
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Discussion with ED will be completed. Plan of correction in writting to be sent to CCL and completed by POC date.
Type B
Section Cited
CCR
82088(e)(1)
Fixtures, Furniture, Equipment, and Supplies
(1) Hot water temperature controls shall be maintained to automatically regulate temperature of hot water delivered to plumbing fixtures to attain a hot water temperature of not less than 105 degrees F (40.5 degrees C) and not more than 120 degrees F (48.8 degrees C).

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on LPA observation, the licensee did not comply with the section cited above in that 2 of 2 water temperatures taken in the kitchen (126.8) and activity room (130.2) measured over 125 degrees F and in need of warning signs. This poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 06/14/2024
Plan of Correction
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Discussion with ED will be completed. Plan of correction in writting to be sent to CCL and completed by POC date.
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:Mary Garza
LICENSING EVALUATOR SIGNATURE:
DATE: 06/05/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 06/05/2024


LIC809 (FAS) - (06/04)
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