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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157200963
Report Date: 04/10/2023
Date Signed: 04/10/2023 02:00:47 PM

Document Has Been Signed on 04/10/2023 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
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: 73DATE:
04/10/2023
TYPE OF VISIT:Case Management - OtherUNANNOUNCEDTIME BEGAN:
09:01 AM
MET WITH:John Noriega, Director of Client ServicesTIME COMPLETED:
02:20 PM
NARRATIVE
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On 4/10/23 at 9:01 AM, Licensing Program Analyst (LPA) Malia Thao arrived unannounced to conduct a case management - other inspection. LPA explained reason for inspection and met with John Noriega, Director of Client Services (JN). Administrator (ADM) Rhonda Glenn was not available for the inspection.

LPA asked if S1 was presently working in the facility. JN pulled the staff schedule and it was observed that S1 was not listed as a scheduled employee. After further investigation, it was determined that S1 may have been placed through the hiring process but was not hired and/or never worked in the facility. JN advised JN was not familiar with named S1. LPA informed JN that there is a Decision and Order excluding S1 and S1 is not allowed to be present in the facility or have contact with any clients. A Civil Penalty will be assessed if S1 is found to be working or present in the facility. LPA advised JN that S1 will need to be removed from the facility roster.
CCL received Special Incident Reports (SIRs) from the facility concerning two separate AWOL incidents that occurred on 10/19/22 and 11/3/22. LPA investigated both incidents. On 10/19/22, C1 eloped from the facility two times but was shadowed by staff during both elopements from the facility. On 11/3/22, C2 eloped from the facility. It is unknown exactly how long C2 was missing before S2 discovered C2 missing. S2 immediately notified the manager and several staff were sent to look for C2. Approximately 45 minutes later, the facility was called by a nearby medical office to report C2 was there. JN picked C2 up from the hospital 6 minutes later. C2's Physician's Report shows C2 cannot leave the facility unassisted. C2's Individual Program Plan (IPP) shows C2 has a history of elopement.

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 and a Plan of Correction was reviewed and developed with JN. A copy of this report and appeal rights were discussed and left with Director of Client Services John Noriega, whose signature on this form confirms receipt of these documents.
SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Malia Thao
LICENSING EVALUATOR SIGNATURE: DATE: 04/10/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 04/10/2023
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 2
Document Has Been Signed on 04/10/2023 02:00 PM - It Cannot Be Edited


Created By: Malia Thao On 04/10/2023 at 12:04 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: 04/10/2023
Deficiency Type
POC Due Date /
Section Number
DEFICIENCIES
PLAN OF CORRECTIONS(POCs)
Type A
04/11/2023
Section Cited
CCR
82078(a)

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82078 Responsibility for Providing Care and Supervision (a) The licensee shall provide care and supervision necessary to meet the client's needs and all services specified in the admission agreement.

This requirement was not met as evidenced by:
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Licensee will submit proof of an in-service training roster, including training material(s), of all staff to address client safety and elopement procedures, to CCL by POC due date.
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LPA found that on 11/3/22, C2 eloped from the facility. It is unknown exactly how long C2 was missing before S2 discovered C2 missing. Approximately 45 minutes later, the facility was called by a nearby medical clinic to report C2 was there. C2's Physician's Report shows C2 cannot leave the facility unassisted. C2's Individual Program Plan (IPP) shows C2 has a history of elopement. This poses an immediate safety and personal rights risk to clients in care.
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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:Malia Thao
LICENSING EVALUATOR SIGNATURE:
DATE: 04/10/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 04/10/2023


LIC809 (FAS) - (06/04)
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