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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157202789
Report Date: 07/21/2023
Date Signed: 07/21/2023 02:37:34 PM

Document Has Been Signed on 07/21/2023 02:37 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:SVS BAKERSFIELD ADULT DAY PROGRAMFACILITY NUMBER:
157202789
ADMINISTRATOR:MENDEZ, CINTHYA GONZALEZFACILITY TYPE:
775
ADDRESS:3601 UNION AVETELEPHONE:
(661) 323-0533
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93305
CAPACITY: 90CENSUS: 39DATE:
07/21/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:06 AM
MET WITH:Latisha Albritton, Administrator (Regional Director)TIME COMPLETED:
03:00 PM
NARRATIVE
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On 7/21/23 at 9:06 AM, Licensing Program Analyst (LPA) Malia Thao arrived unannounced to conduct an Annual inspection. LPA explained reason for inspection and met with Case Manager Lupita Velasquez. Administrator (ADM) Latisha Albritton arrived a short time later.

LPA toured the facility and did not observe any obstructions. Facility does not use outdoor space for clients. Facility was set at a comfortable temperature. Chemicals observed inaccessible in storage closet. Fire extinguishers all serviced 3/17/23. Facility has an installed pull station fire alarm. Centrally stored medication observed locked in kitchen cabinet. A sample of staff and client records were reviewed. Hot water measured at 113.8 degrees F in the south women's restroom and 114.1 degrees F in the north women's restroom. Hand sanitizer was readily available.

The following deficiencies were observed:
1. LPA observed a spray bottle of cleaner in the storage drawer cart in the south women's restroom; and Blender blades observed accessible in blender on the counter and in the dish rack.
2. Facility does not have carbon monoxide detectors.
3. ADM's health screening does not indicate whether ADM has good physical health.

Deficiencies are being cited based on LPA observation, interview conducted, and record review in accordance with the California Code of Regulations, Title 22, see LIC809D. An exit interview was conducted and Plans of Corrections were reviewed and developed with the Administrator. A copy of this report and appeal rights were discussed and left with Administrator, whose signature on this form confirms receipt of these documents.

The following updated documents are to be submitted within 2 weeks:


LIC308, LIC500, LIC9020, LIC610D (new revision), Copy of current Plan of Operation, updated facility sketch (floor plan)
SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Malia Thao
LICENSING EVALUATOR SIGNATURE: DATE: 07/21/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/21/2023
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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Document Has Been Signed on 07/21/2023 02:37 PM - It Cannot Be Edited


Created By: Malia Thao On 07/21/2023 at 01:53 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: SVS BAKERSFIELD ADULT DAY PROGRAM
FACILITY NUMBER: 157202789

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/21/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
82087(a)(3)
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. (3) Disinfectants, cleaning solutions, poisons, and other items which could pose a danger if readily available to clients shall be stored where inaccessible to clients.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above. LPA observed a spray bottle of cleaner in the storage drawer cart in the south women's restroom; and Blender blades observed accessible in blender on the counter and in the dish rack. which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 07/21/2023
Plan of Correction
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Administrator immediately removed the cleaner spray bottle and two blender blades to an inaccessible area. POC cleared during the inspection.
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:Malia Thao
LICENSING EVALUATOR SIGNATURE:
DATE: 07/21/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/21/2023


LIC809 (FAS) - (06/04)
Page: 2 of 5
Document Has Been Signed on 07/21/2023 02:37 PM - It Cannot Be Edited


Created By: Malia Thao On 07/21/2023 at 01:53 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: SVS BAKERSFIELD ADULT DAY PROGRAM
FACILITY NUMBER: 157202789

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 07/21/2023

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
HSC
1503.2
General Provisions
Every facility licensed or certified pursuant to this chapter shall have one or more carbon monoxide detectors in the facility that meet the standards established in Chapter 8 (commencing with Section 13260) of Part 2 of Division 12. The department shall account for the presence of these detectors during inspections.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, the licensee did not comply with the section cited above. Facility does not have carbon monoxide detectors, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/24/2023
Plan of Correction
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Administrator will submit proof of installed and operational carbon monoxide detectors, to CCL by POC due date.
Type B
Section Cited
CCR
82065(g)(1)
Personnel Requirements
(1) The good physical health of each employee and individual licensee shall be verified by a health screening, including negative test results for tuberculosis, performed by or under the supervision of a physician not more than one year prior to or seven days after employment or licensure.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on record review, the licensee did not comply with the section cited above. ADM's health screening does not indicate whether ADM has good physical health, which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/28/2023
Plan of Correction
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Administrator will submit proof of ADM's health screening indicating good physical health, to CCL by POC due date.
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: 07/21/2023
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/21/2023


LIC809 (FAS) - (06/04)
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