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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157202789
Report Date: 03/26/2024
Date Signed: 03/27/2024 04:18:15 PM

Document Has Been Signed on 03/27/2024 04:18 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:GREEN, VICTORIA A.FACILITY TYPE:
775
ADDRESS:3601 UNION AVETELEPHONE:
(661) 323-0533
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93305
CAPACITY: 90CENSUS: 50DATE:
03/26/2024
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
09:45 AM
MET WITH:Program director, Victoria GreenTIME COMPLETED:
11:30 AM
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On 3/26/24 at 09:45 AM, Licensing Program Analyst (LPA) V. Gorban arrived unannounced to conduct a case management inspection. LPA explained the reason for the visit and met with Program Director (PD) Victoria Green.

LPA toured the facility inside and out to conduct safety checks.

Regional office received an incident report occurred on 03/19/2024 facility staff pushed client (C1). During this visit LPA interviewed Program Director Victoria Green, client (C1), facility staff (S1), and a witness (S3) to the incident.
LPA requested facility files for further review.


NO deficiencies were observed or cited during this visit.

Exit interview conducted, report signed and copy of this report provided for facility records.
SUPERVISORS NAME: Brenda Chan
LICENSING EVALUATOR NAME: Vadim Gorban
LICENSING EVALUATOR SIGNATURE: DATE: 03/26/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/26/2024
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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