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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 150404353
Report Date: 01/13/2025
Date Signed: 01/13/2025 12:00:43 PM

Document Has Been Signed on 01/13/2025 12:00 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-TAFT, THEFACILITY NUMBER:
150404353
ADMINISTRATOR/
DIRECTOR:		HAGSTROM, MARYANNFACILITY TYPE:
775
ADDRESS:204 VAN BUREN STREETTELEPHONE:
(661) 763-1532
CITY:TAFTSTATE: CAZIP CODE:
93268
CAPACITY: 45CENSUS: 26DATE:
01/13/2025
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:15 AM
MET WITH:Administrator Maryann HagstromTIME VISIT/
INSPECTION COMPLETED:
12:15 PM
NARRATIVE
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On 01/13/25, Licensing Program Analyst (LPA) M. Yang arrived unannounced to conduct an Annual
inspection. LPA introduced self, stated the purpose of the visit and met with Administrator Maryann Hagstrom. LPA completed a tour of the facility with Administrator. Clients were observed in the activity rooms.

The facility is maintained at a comfortable temperature and no passageway obstructions or fire hazards were observed. Outside was observed clear of debris with adequate outdoor space and seatings for clients. Transportation is available and provided for clients. Fire extinguishers throughout the facility was observed with served date: 11/04/24. Last fire drill completed on 01/08/25. Kitchen was toured and observed refrigerator at 38 degrees F. Clients bring their own lunch and snacks to the program. Kitchen was toured. Sharps observed stored and locked in kitchen cabinet.

LPA observed medications locked in the facility medication room. MAR was reviewed. Medication was checked. LPA observed clients’ personal basket in the front entrance. Client bathrooms were tour, observed to be clean, and operational. Hot water temperature was 112.2 degrees F in bathroom 1 and 110.9 degrees F in bathroom 2. A sample of client and staff files were also reviewed.

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: 01/20/25. 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: 01/13/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 01/13/2025
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 01/13/2025 12:00 PM - It Cannot Be Edited


Created By: Mai Yang On 01/13/2025 at 11:51 AM
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-TAFT, THE
FACILITY NUMBER: 150404353

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 01/13/2025

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
82065(g)(1)
82065 (g)(1) The good physical health of each employee and individual licensee shall be verified by a health screening, including negative test results for tuberculosis, performed by or under the supervision of a physician not more than one year prior to or seven days after employment or licensure.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on records review, S1 did not have health screening and TB result on file which poses a potential risk to the health and safety of the clients.
POC Due Date: 01/31/2025
Plan of Correction
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Licensee shall ensure all staff have a good health screening and negative TB result completed on file. S1 good health screening and negative TB results shall be submitted to the Fresno CCL office by POC due date 01/31/25.
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: 01/13/2025
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 01/13/2025


LIC809 (FAS) - (06/04)
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