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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157200749
Report Date: 10/01/2024
Date Signed: 10/01/2024 11:36:00 AM

Document Has Been Signed on 10/01/2024 11:36 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:MERCIE'S DAY PROGRAMFACILITY NUMBER:
157200749
ADMINISTRATOR/
DIRECTOR:		DE CLARO, GERALDFACILITY TYPE:
775
ADDRESS:2700 K STREETTELEPHONE:
(661) 323-5585
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93301
CAPACITY: 49CENSUS: 48DATE:
10/01/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
11:19 AM
MET WITH:Administrator, Gerald De ClaroTIME VISIT/
INSPECTION COMPLETED:
11:45 AM
NARRATIVE
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On 10/01/2024, Licensing Program Analyst (LPA) Walton arrived unannounced to conduct a case management inspection. LPA introduced self, stated the purpose of the visit and met with Administrator, Gerald De Claro.

During the investigation for complaint #24-AS-20240821114317, LPA conducted a file review. Upon review of the file, LPA found that the facility did not report two incidents where S1 fell asleep while transporting clients.

Based on record review, a deficiency is being cited in accordance to California Code of Regulations, Title 22, Division 6 on the attached 809D.

An exit interview was conducted, and a plan of correction was reviewed and developed. A copy of this report and appeal rights were discussed and provided to Administrator, Gerald De Claro., whose signature on this form confirms receipt of this document.

SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Alexandria Walton
LICENSING EVALUATOR SIGNATURE: DATE: 10/01/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/01/2024
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 10/01/2024 11:36 AM - It Cannot Be Edited


Created By: Alexandria Walton On 10/01/2024 at 11:21 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: MERCIE'S DAY PROGRAM
FACILITY NUMBER: 157200749

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/01/2024
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type B
10/15/2024
Section Cited
CCR
82061(a)

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82061 Reporting Requirements
(a) Upon the occurrence, during the hours the day program is providing services to the client… a report shall be made to the licensing agency within the agency's next working day during its normal business hours. In addition, a written
report containing the information… shall be submitted to the licensing agency within seven days following the occurrence of the event… This requirement was not met as evidenced by:
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Licensee agrees to submit a written statement detailing the steps the facility will take to ensure the requirements for this section is met to the Fresno CCL office by the POC due date.
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Based on record review, the Licensee did not ensure the requirements for section 82061 were met when the facility did not report two incidents where S1 fell asleep while transporting clients 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:Melinda Hoffmann
LICENSING EVALUATOR NAME:Alexandria Walton
LICENSING EVALUATOR SIGNATURE:
DATE: 10/01/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/01/2024


LIC809 (FAS) - (06/04)
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