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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157200963
Report Date: 07/20/2023
Date Signed: 07/20/2023 09:32:32 AM

Document Has Been Signed on 07/20/2023 09:32 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
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: 25DATE:
07/20/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:00 AM
MET WITH:John Noreiga, AdministratorTIME COMPLETED:
09:45 AM
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On 7/20/23 at 9:00 AM, Licensing Program Analyst (LPA) Malia Thao arrived unannounced to conduct a case management - other inspection. LPA explained reason for inspection and met with Administrator (ADM) John Noreiga.

During a recent inspection on 7/11/23, LPA observed the facility’s use of rooms in Buildings A and B did not match the facility sketches on file and had changed, including a removal of a wall in Building A. Facility sketches on file need updating to reflect the correct building identifier, as well as correct cleared capacity per building, which would require an updated fire clearance (STD. 850).

LPA is requesting the facility to submit a completed LIC9054 and updated facility sketches (LIC 999, floor plan and yard) to Fresno Regional Office within two weeks. The updated facility sketches (floor plan) are to include for each room: designated use, capacity, dimensions, and number of non-ambulatory clients, if any. Facility sketch (floor plan) must also include a designated sick room [CCR 82087(d)], locations of video surveillance cameras, all utility shut-off locations, and exit routes numbered, to match exit numbering on the facility’s Emergency Disaster Plan. If abbreviations are used, a key must be included on each facility sketch. If the total number of non-ambulatory clients will be different than the current approved capacity, an application for change of capacity will be required.

Facility is to submit updated LIC309 and LIC610D to CCL within two weeks.

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: 07/20/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/20/2023
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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