<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157200963
Report Date: 02/16/2023
Date Signed: 02/16/2023 03:12:13 PM

Document Has Been Signed on 02/16/2023 03:12 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: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: 87DATE:
02/16/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:02 AM
MET WITH:Pamela Williams, Manager
John Noriega, Director of Client Services		TIME COMPLETED:
03:30 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 2/16/23 at 10:02 AM, Licensing Program Analyst (LPA) Malia Thao arrived unannounced to conduct an Annual inspection. LPA explained reason for inspection and met with Manager Pamela Williams and Director of Client Services John Noriega. Administrator was not available for the inspection.

LPA toured inside and outside of building A and B. Facility was observed clean and without any obstructions or fire clearance issues. Hand sanitizer was readily available to client and visitors. Social distancing and masking is maintained in the common areas. Cleaning and PPE supplies were checked. Medications were centrally stored and inaccessible. COVID-19 signs observed posted.

The following deficiencies were observed:
1. S1, S2, and S3 do not have completed transfer of criminal record clearances. S1 has been working in the facility since 11/7/22. S2 has been working in the facility since 8/11/22. S3 has been working in the facility since 8/4/22.
2. One Lysol cleaner spray bottle observed accessible in unlocked cabinet under sink in kitchen of building B.
3. Three ceiling panels observed removed exposing wires and insulation in accessible room #3 in building B.

Deficiencies are being cited based on LPA observation, interviews, and record review in accordance with the California Code of Regulations, Title 22, see LIC809D. A civil penalty is being assessed in the amount of $100 per day, for a maximum of 5 days, for a total of $1500 for S1, S2, and S3. See LIC421BG for more details.

The following forms are to be submitted to CCL within 2 weeks: LIC500, LIC610D (new revision), LIC308

Exit interview conducted and Plan of Corrections were reviewed and developed with Director of Client Services John Noriega. A copy of this report and appeal rights were given to John Noriega, whose signature confirms receipt of this report.

SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Malia Thao
LICENSING EVALUATOR SIGNATURE: DATE: 02/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 02/16/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 4
Document Has Been Signed on 02/16/2023 03:12 PM - It Cannot Be Edited


Created By: Malia Thao On 02/16/2023 at 12:54 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: KERN ADULT PROGRAM, INC.
FACILITY NUMBER: 157200963

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/16/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
82087(a)(3)
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. (3) Disinfectants, cleaning solutions, poisons, and other items which could pose a danger if readily available to clients shall be stored where inaccessible to clients.

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. LPA observed one Lysol cleaner spray bottle accessible in unlocked cabinet under sink in kitchen of building B, which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 02/16/2023
Plan of Correction
1
2
3
4
Licensee immediately removed Lysol cleaner spray bottle and secured it in designated inaccessible storage closet in buidling B. POC cleared during inspection.
Type A
Section Cited
CCR
82019(e)(2)
Criminal Record Clearance
(e) Prior to working, residing or volunteering in a licensed day program, all individuals subject to a criminal record review pursuant to Health and Safety Code Section 1522 shall do the following: (2) Request the licensee or applicant for a license to request a transfer of a criminal record clearance as specified in Section 82019(f); or

This requirement is not met as evidenced by:
Deficient Practice Statement
1
2
3
4
Based on interview and record review, the licensee did not comply with the section cited above. S1, S2, and S3 do not have completed transfer of criminal record clearances. S1 has been working in the facility since 11/7/22. S2 has been working in the facility since 8/11/22. S3 has been working in the facility since 8/4/22. Which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 02/17/2023
Plan of Correction
1
2
3
4
S1, S2, and S3 were removed from the facility during the inspection. Licensee will submit proof of a plan to ensure all staff have completed transfer of criminal record clearance before allowing staff to work in the facility, to CCL by POC due date.
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: 02/16/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/16/2023


LIC809 (FAS) - (06/04)
Page: 2 of 4
Document Has Been Signed on 02/16/2023 03:12 PM - It Cannot Be Edited


Created By: Malia Thao On 02/16/2023 at 12:54 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: KERN ADULT PROGRAM, INC.
FACILITY NUMBER: 157200963

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 02/16/2023

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. LPA observed three ceiling panels removed exposing wires and insulation in accessible room #3 in building B. which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 03/02/2023
Plan of Correction
1
2
3
4
Licensee immediately locked door to room #3. Licensee will submit proof of all three ceiling panels replaced to CCL by POC due date.
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: 02/16/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 02/16/2023


LIC809 (FAS) - (06/04)
Page: 3 of 4