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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157202789
Report Date: 07/29/2022
Date Signed: 07/29/2022 10:20:56 AM

Document Has Been Signed on 07/29/2022 10:20 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
CCLD Regional Office, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME:SVS BAKERSFIELD ADULT DAY PROGRAMFACILITY NUMBER:
157202789
ADMINISTRATOR:COPELAND, SUZANNEFACILITY TYPE:
775
ADDRESS:3601 UNION AVETELEPHONE:
(661) 323-0533
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93305
CAPACITY: 90CENSUS: 64DATE:
07/29/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
08:12 AM
MET WITH:Administrator Cynthia Mendez Gonzalez TIME COMPLETED:
10:30 AM
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On 7/29/22, Licensing Program Analyst (LPA) M. Yang arrived unannounced to conduct an Annual Inspection - Infection Control. LPA introduced self, stated the purpose of the visit, and requested to meet with Administrator. LPA met with Program Administrator Assistant Bertha Sanchez. Administrator Cynthia Mendez Gonzalez was called and arrived shortly. There are currently 10 clients present during tour.

Visitors log-in/temperature check was observed upon entry. Hand sanitizer was readily available to clients and visitors. LPA observed staff with facial covering. Visitor LPA observed 30-day PPE supply. Client restrooms were tour, observed to be clean, and operational. LPA observed hand washing posting by all sinks. Social distancing is maintained in the common areas. LPA observed social distancing and cough etiquette postings in facility.

The Day Program has 12 classrooms separated into cohort for activities.

A sample of client files were also reviewed to have updated emergency contact information. Staff files have current 1st Aid.

No deficiencies issued.

Exit Interview conducted. The following documents are requested and to be submitted to Fresno CCL by: 8/4/22. The following updated forms were requested: Lic 308, Lic 309 (if applicable), Lic 500, Lic 610D, Lic 9020, and current Administrator certificate. A copy of this report was provided to the Administrator.

SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Mai Yang
LICENSING EVALUATOR SIGNATURE: DATE: 07/29/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/29/2022
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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