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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157200963
Report Date: 07/18/2022
Date Signed: 07/18/2022 02:00:46 PM

Document Has Been Signed on 07/18/2022 02:00 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
CCLD Regional Office, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME:KERN ADULT PROGRAM, INC.FACILITY NUMBER:
157200963
ADMINISTRATOR:GLENN, RHONDAFACILITY TYPE:
775
ADDRESS:2900 EYE ST.TELEPHONE:
(661) 323-4700
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93301
CAPACITY: 120CENSUS: 62DATE:
07/18/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
12:39 PM
MET WITH:Administrator, John NoriegaTIME COMPLETED:
02:16 PM
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On 7/18/2022 Licensing Program Analyst (LPA) M. Garza arrived at facility to complete a case management visit. Administrator, John Noriega was contacted and arrived a short time later. LPA introduced self and explained reason for visit. LPA was COVID pre-screened and permitted entry to the building. A Health and Safety check was completed on clients in care. LPA observed clients in 2 separate buildings in activity rooms and completing activities.

CCL received a self reported special incident report on Client #1 (C1) leaving the facility unsupervised. C1's IPP's, physicians report and special incident reports were reviewed.

Interview with Administrator revealed C1 left the facility to go to the bus and contact/visual was lost on C1. Administrator reviewed AWOL plan with LPA. Staff witnessed C1 leave the facility and immediately put that plan into action by going to locate C1 and return them to the facility.

C1's physicians report was reviewed and showed that C1 is able to leave the facility unsupervised.

No deficiencies cited during this visit.

An exit interview was completed and a copy of this report was given.
SUPERVISORS NAME: See Moua
LICENSING EVALUATOR NAME: Mary Garza
LICENSING EVALUATOR SIGNATURE: DATE: 07/18/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/18/2022
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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