157200749-10-20-2023-24-AS-MTHO-CWSTBW-20231020143549

Community Care Licensing

FACILITY EVALUATION REPORT

Facility Number: 157200749
Report Date: 10/20/2023
Date Signed: 10/20/2023 02:35:54 PM

Document Has Been Signed on 10/20/2023 02:35 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:	MERCIE'S DAY PROGRAM		FACILITY NUMBER:	157200749
ADMINISTRATOR:	DE CLARO, GERALD		FACILITY TYPE:	775
ADDRESS:	2700 K STREET		TELEPHONE:	(661) 323-5585
CITY:	BAKERSFIELD	STATE: CA	ZIP CODE:	93301
CAPACITY: 49		CENSUS: 44	DATE:	10/20/2023
TYPE OF VISIT:	Required - 1 Year	UNANNOUNCED	TIME BEGAN:	09:44 AM
MET WITH:	Gerald De Claro, Administrator Calvin Sheppard, Program Manager		TIME COMPLETED:	02:55 PM

NARRATIVE

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On 10/20/23 at 9:44 AM, Licensing Program Analyst (LPA) Malia Thao arrived unannounced to conduct an Annual inspection. LPA explained reason for inspection and met with Administrator (ADM) Gerald De Claro and Program Manager (PM) Calvin Sheppard.

LPA toured the facility and did not observe any obstructions. Facility was set at a comfortable temperature. Facility has an installed pull station fire alarm. Carbon monoxide detectors tested and operational. Fire extinguisher last serviced 10/19/23. Hot water in women's restroom measured at 105.1 degrees F. LPA observed centrally stored medication in PM's locked office. Sick room observed. Chemicals are stored in locked laundry room. A sample of staff and client records were reviewed.

The following deficiencies were observed:
1. One of two toilets in women's restroom observed without a toilet tank lid and handle; men's restroom observed with strong urine smell by urinal; toilet paper holders observed unclean in men's and women's restrooms; flooring around toilet in women's restroom observed lifting from the wall; and bathroom stall doors in men's and women's restroom observed with missing latch slide keeper bumpers.

Deficiency is being cited based on LPA observation conducted in accordance with the California Code of Regulations, Title 22, see LIC809D.

An exit interview was conducted and a Plan of Correction was reviewed and developed with the Administrator. A copy of this report and appeal rights were discussed and left with Administrator, whose signature on this form confirms receipt of these documents.

The following updated documents are to be submitted within 2 weeks:

LIC308, LIC500, LIC9020

SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Malia Thao
LICENSING EVALUATOR SIGNATURE:	DATE: 10/20/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/20/2023

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 10/20/2023 02:35 PM - It Cannot Be Edited

Created By: Malia Thao On 10/20/2023 at 01:48 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: MERCIE'S DAY PROGRAM	FACILITY NUMBER: 157200749
DEFICIENCY INFORMATION FOR THIS PAGE:	VISIT DATE: 10/20/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)

Type B

Section Cited

CCR

82087(a)

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. This requirement is not met as evidenced by:
	Deficient Practice Statement
1 2 3 4	Based on observation, the licensee did not comply with the section cited above. One of two toilets in women's restroom observed without a toilet tank lid and handle; men's restroom observed with strong urine smell by urinal; toilet paper holders observed unclean in men's and women's restrooms; flooring around toilet in women's restroom observed lifting from the wall; and bathroom stall doors in men's and women's restroom observed with missing latch slide keeper bumpers, which poses a potential health, safety or personal rights risk to persons in care.
	POC Due Date: 11/20/2023
	Plan of Correction
1 2 3 4	Toilet in women's restroom replaced during the inspection. Administrator will complete a deep cleaning of area of urinal in men's restroom; all toilet paper holders will be cleaned; flooring around toilet in women's restroom will be replaced; and will be installing latch slide keeper bumpers for all stall doors. LPA will return for a POC visit.

Section Cited


	Deficient Practice Statement
1 2 3 4
	POC Due Date:
	Plan of Correction
1 2 3 4

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:

Melinda Hoffmann

LICENSING EVALUATOR NAME:

Malia Thao

LICENSING EVALUATOR SIGNATURE:

DATE: 10/20/2023

I acknowledge receipt of this form and understand my appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/20/2023

LIC809 (FAS) - (06/04)

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