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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157200963
Report Date: 03/08/2024
Date Signed: 03/08/2024 05:56:23 PM

Document Has Been Signed on 03/08/2024 05:56 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
CCLD Regional Office, 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: 78DATE:
03/08/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:30 PM
MET WITH:Administrator John NoriegaTIME COMPLETED:
04:45 PM
NARRATIVE
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On 03/08/24, Licensing Program Analyst (LPA) L. Salazar arrived to the facility unannounced to conduct the required Annual Inspection Visit. LPA was greeted by Administrator, stated the purpose of the visit and was allowed entry into the facility. Administrator provided a tour of the facility inside and out.

LPA toured the facility with Administrator and observed 2 buildings, classrooms, common areas and bathrooms. Classrooms were observed to have a ratio of 3 clients to 1 staff. Activity schedules were observed. Facility was observed to be free from any passageway obstruction / fire hazards. Facility temperature was 72 degrees F. Bathrooms were toured and observed to have operational lights, running water. Hot water temperature tested at 109 degrees F. Hand washing postings were observed.

Cleaning supplies were observed to be locked. First aid kit was observed and contained all required items. Carbon monoxide detectors were observed to be operational. Fire Extinguishers were observed with a service date of 05/12/23. Last Disaster drill was 02/09/24. The exterior tour of facility’s activities area was conducted and found to be free from debris. A covered outdoor seating area was observed for client’s in care. A sample of resident and staff files were observed to have the required documents.

A deficiency is being cited based on LPA's record review and interview conducted in accordance with the California Code of Regulations, Title 22, see LIC809D. An exit interview was conducted with Administrator. A copy of this report was discussed and provided at the time of visit.
SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Lisa Salazar
LICENSING EVALUATOR SIGNATURE: DATE: 03/08/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/08/2024
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 03/08/2024 05:56 PM - It Cannot Be Edited


Created By: Lisa Salazar On 03/08/2024 at 03:46 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: 03/08/2024

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
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LPAs observation of the flooring in Large Activity room located in Building "B" is stained and needs replacement. In not corrected, the violation poses a potential risk to health safety or personal rights of clients in care.
POC Due Date: 04/08/2024
Plan of Correction
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Licensee will replace the floors in the large activity room in Building "B" by POC date. Licensee will send pictures to LPA via text or email.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:Lisa Salazar
LICENSING EVALUATOR SIGNATURE:
DATE: 03/08/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/08/2024


LIC809 (FAS) - (06/04)
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