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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157200963
Report Date: 07/11/2023
Date Signed: 07/11/2023 01:56:36 PM

Document Has Been Signed on 07/11/2023 01:56 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:NORIEGA, JOHNFACILITY TYPE:
775
ADDRESS:2900 EYE ST.TELEPHONE:
(661) 323-4700
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93301
CAPACITY: 120CENSUS: 81DATE:
07/11/2023
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
12:43 PM
MET WITH:John Noriega, Administrator
Pam Williams, Manager		TIME COMPLETED:
02:30 PM
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On 7/11/23 at 12:45 PM, Licensing Program Analyst (LPA) Malia Thao conducted an unannounced case management - incident inspection. LPA met with Administrator (ADM) John Noreiga and Manager (MAN) Pam Williams.

CCL received a self reported Special Incident Report (SIR) involving C1. Facility reported being informed by Kern Regional Center (KRC) that C1 alleged staff and clients bullied C1. Facility reported interviewing parties involved.

LPA reviewed records and conducted interviews. LPA could not interview C1 as C1 had left the facility earlier in the morning. S1 denied bullying C1 or calling C1 names. S1 states S1 does not work directly with C1 and recalls having had only two interactions with C1 where S1 diffused the situation and redirected C1.

No deficiencies cited during today's inspection.

Exit interview conducted. A copy of this report was given to Administrator, whose signature confirms receipt of this report.
SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Malia Thao
LICENSING EVALUATOR SIGNATURE: DATE: 07/11/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/11/2023
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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