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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 150404353
Report Date: 11/21/2022
Date Signed: 11/21/2022 10:00:23 AM

Document Has Been Signed on 11/21/2022 10:00 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
CCLD Regional Office, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME:ARC-TAFT, THEFACILITY NUMBER:
150404353
ADMINISTRATOR:HAGSTROM, MARYANNFACILITY TYPE:
775
ADDRESS:204 VAN BUREN STREETTELEPHONE:
(661) 763-1532
CITY:TAFTSTATE: CAZIP CODE:
93268
CAPACITY: 45CENSUS: 24DATE:
11/21/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:30 AM
MET WITH:Maryann Hagstrom, Administratorm and Tiffanie Morgan, Administrator AssistantTIME COMPLETED:
10:15 AM
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On 11/21/22/22, Licensing Program Analyst (LPA) M. Yang arrived unannounced to conduct an Annual Inspection - Infection Control. LPA met Tiffanie Morgan, Administrator Assistant. Eight clients were present during the inspection. Maryann Hagstrom, Administrator was called and arrived later during the inspection. LPA completed a tour of the facility with Administrator Assistant.

Visitor log-in/temperature check was observed upon entry. Hand sanitizer was readily available to clients and visitors. LPA observed 30-day PPE supply. Client restrooms were tour, observed to be clean, and operational. LPA observed hand washing posting by all sinks. Social distancing is maintained in the common areas. LPA observed social distancing and cough etiquette postings in facility.

Facility is maintained at a comfortable temperature and no passageway obstructions or fire hazards were observed inside or outside. LPA observed medications locked in cabinet in facility medication room. Client bring their own snacks. LPA observed fire extinguisher served date: 10/21/22.

Half of client files were also reviewed to have updated emergency contact information. Staff files have current 1st Aid and infection control training.

No deficiencies issued during this inspection.

Exit Interview conducted. The following documents are requested and to be submitted to Fresno CCL by: 11/28/22. The following updated forms were requested: Lic 308, Lic 500, Lic 610D, and Lic 9282. A copy of this report was provided to the Administrator and Administrator Assistant.

SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Mai Yang
LICENSING EVALUATOR SIGNATURE: DATE: 11/21/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/21/2022
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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