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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 107207171
Report Date: 09/27/2024
Date Signed: 09/27/2024 02:12:11 PM

Document Has Been Signed on 09/27/2024 02:12 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, 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: 20DATE:
09/27/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:38 AM
MET WITH:Case Manager, Robert PerezTIME VISIT/
INSPECTION COMPLETED:
02:21 PM
NARRATIVE
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On 9/27/24 Licensing Program Analyst (LPA) M. Garza completed an unannounced case management visit. LPA met with Robert Perez and was notified the Program Manager, Kelly Wheeler was not available. LPA explained reason for visit and was permitted entry into the facility. A health and safety was completed on clients in care. Clients observed in common areas and in activity rooms.

This case management visit is being conducted for Special Incident Reports received by Community Care Licensing.

Incident #1: C1 did not report to day program for 30 days. Facility attempted to reach father, brother and client without success. A SOC 341 was completed and cross reported to CCL, CVRC, APS and FCSO. FCSO completed a well check on C1. Documentation reviewed and interviews were completed. The facilities policy for reporting was followed. No deficiencies cited for this incident.

Incident #2: C2 takes 3 medications daily at program. On 8/5/24 facility was short staffed and medications were not provided to C2. Facility missed window to provide C2 medications. Trained staff was not at facility to provide medications within the required time frame. Documentation was reviewed and interviews were completed. Deficiency cited for missed medications per Title 22.

Incident #3: C3 came to program with injury to back. RP (mom) reported a fall. C3 reported it was "dad/moms fault". Prior to this injury C3 was given extra support and medications adjusted. Documentation was reviewed and interviews were completed. Facility cross reported to appropriate agencies. No deficiencies cited for this incident.

CONT...
SUPERVISORS NAME: See Moua
LICENSING EVALUATOR NAME: Mary Garza
LICENSING EVALUATOR SIGNATURE: DATE: 09/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 09/27/2024
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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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		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 CTR
FACILITY NUMBER: 107207171
VISIT DATE: 09/27/2024
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CONT...

Incident #4: Facility reported C4 informed their Case Coordinator they were being bullied and having items stolen from them at program. Documentation was reviewed and interviews were completed. Meeting is being set up with Unique Families to address this at home. No deficiencies cited for this incident.

Incident #5: C5 reported their IHSS worker is stealing from them at home. Reedley PD, CVRC, ILP and CCL notified. Documentation has been reviewed and interviews completed. Facility is following their reporting policy. No deficiencies cited for this incident.

Incident #6: C6 attended an outing with 4 peers and 2 staff. 1 client/staff being a 1:1 ratio. During a restroom/food stop C6 was left without supervision. Documentation was reviewed and interviews were completed. Case Manager confirmed incident occurred. Deficiency issued for personnel requirements per Title 22.

Incident #7: RP (mom) reported C7 woke up with a swollen lip. C7 was taken to ER and was diagnosed with unknown allergy. Documentation was reviewed and interviews were completed. 8/15/24 annual meeting placed C7 on Restricted Health Care Plan. Facility has plan in place with all parties. No deficiency cited for this incident.

Exit interview completed with Case Manager, Robert Perez. A copy of this report, deficiencies and appeal rights provided.
SUPERVISORS NAME: See Moua
LICENSING EVALUATOR NAME: Mary Garza
LICENSING EVALUATOR SIGNATURE:

DATE: 09/27/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 09/27/2024
LIC809 (FAS) - (06/04)
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Document Has Been Signed on 09/27/2024 02:12 PM - It Cannot Be Edited


Created By: Mary Garza On 09/27/2024 at 01:32 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: 09/27/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
09/30/2024
Section Cited
CCR
82075(b)

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82075 Health-Related Services
(b) Clients shall be assisted as needed with self-administration of prescription and nonprescription medications.
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Plan of correction to be provided to CCL in writting by POC date. Facility notified family, all staff training for medications, and inplement digital reminder for staff to provide medication and posting on teams for documentation to show medication was provided.
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This requirement was not met as evidence by: LPA's interviews and review of medication log for 8/5/24. Facility did not provide medication to C2 as prescribed and missed the wiindow to provide C2 with their medications. This posed an immediate health safety, and/or personal rights risk to client in care.
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Type A
09/30/2024
Section Cited
CCR82065(a)

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82065 Personnel Requirements
(a) Program personnel shall be competent to provide the services necessary to meet individual client needs and shall, at all times, be employed in numbers necessary to meet such needs.
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Plan of correction to be provided to CCL in writting by POC date. Facility completed all staff training, implemented head count policy, termination for staff involved.
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This requirement was not met as evidence by: LPA's interivew with Case Manager. Case Manager confirmed C6 was left behind during a restroom/food stop without supervision. This posed an immediate health safety, and/or personal rights risk to client in care.
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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:Mary Garza
LICENSING EVALUATOR SIGNATURE:
DATE: 09/27/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 09/27/2024


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