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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157202789
Report Date: 07/15/2024
Date Signed: 07/15/2024 02:45:18 PM

Document Has Been Signed on 07/15/2024 02:45 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:SVS BAKERSFIELD ADULT DAY PROGRAMFACILITY NUMBER:
157202789
ADMINISTRATOR/
DIRECTOR:		GREEN, VICTORIA A.FACILITY TYPE:
775
ADDRESS:3601 UNION AVETELEPHONE:
(661) 323-0533
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93305
CAPACITY: 90CENSUS: 72DATE:
07/15/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
09:38 AM
MET WITH:Administrator, Victoria GreenTIME VISIT/
INSPECTION COMPLETED:
02:53 PM
NARRATIVE
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On 07/15/2024, Licensing Program Analysts (LPAs) Walton and Leffall arrived unannounced to conduct an annual inspection. LPAs introduced themselves, stated the purpose of the visit and requested to meet with the Administrator. LPAs met with Administrator, Victoria Green.

LPAs toured inside and outside of the facility. No fire hazards or passageway obstructions were observed. LPAs observed sufficient seating and adequate lighting throughout the facility. LPAs observed 5 chairs and 1 couch in need of repair. LPAs toured the client restrooms which appeared clean and operational. Hot water measured at 95 degrees F. The faucets in kitchen 1 and kitchen 2 did not have a water faucet aerator. Clients provide their own meals. Medications are stored on site in a locked cabinet in the kitchen. Fire extinguishers were last serviced on 03/01/2024.

Outside of facility was toured. There are no bodies of water on the premises. Facility records reviewed. LPAs reviewed a sample of client records and found that 5 out of 10 clients did not have an updated IPP on file. LPAs also found that 5 out of 10 clients did not have physician report (medical assessment) on file. LPAs reviewed a sample of personnel records.

Deficiencies are being cited in accordance to California Code of Regulations, Title 22, Division 6 on the attached 809D.

Exit interview conducted and a plan of correction was reviewed and developed with Administrator. A copy of this report and appeal rights were discussed and provided to Administrator, Victoria Green, whose signature on this form confirms receipt of this document.

LPAs are requesting the following documents be submitted to the Fresno CCL office by 07/29/2024:


LIC308, LIC500, LIC9020, LIC610D
SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Alexandria Walton
LICENSING EVALUATOR SIGNATURE: DATE: 07/15/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 07/15/2024
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 7
Document Has Been Signed on 07/15/2024 02:45 PM - It Cannot Be Edited


Created By: Alexandria Walton On 07/15/2024 at 02:10 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: 07/15/2024

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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Based on observation, the licensee did not comply with the section cited above when 5 chairs and 1 couch were in need of repair, and 2 faucets that were in need of repair and which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 08/05/2024
Plan of Correction
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Licensee agrees to make the repairs or replace the items listed above and submit proof of repairs/replacement to the Fresno CCL office by the POC due date.
Type B
Section Cited
CCR
82088(e)(1)
Fixtures, Furniture, Equipment, and Supplies
(1) Hot water temperature controls shall be maintained to automatically regulate temperature of hot water delivered to plumbing fixtures to attain a hot water temperature of not less than 105 degrees F (40.5 degrees C) and not more than 120 degrees F (48.8 degrees C).

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 when hot water measured at 95 degrees F which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 07/24/2024
Plan of Correction
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Licensee agrees to measure water temperature for 7 days and document water temperatures on a water log. Licensee agrees to submit a copy of the water log to the Fresno CCL office by the 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:Alexandria Walton
LICENSING EVALUATOR SIGNATURE:
DATE: 07/15/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/15/2024


LIC809 (FAS) - (06/04)
Page: 2 of 7
Document Has Been Signed on 07/15/2024 02:45 PM - It Cannot Be Edited


Created By: Alexandria Walton On 07/15/2024 at 02:10 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: 07/15/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type B
Section Cited
CCR
82068.2(d)(1)
Needs and Services Plan
(d) If the client has an existing needs appraisal or individual program plan (IPP) completed by a placement agency, or a consultant for the placement agency, the Department may consider the plan to meet the requirements of this section provided that: (1) The needs appraisal or IPP is not more than one year old.

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 when 5 out of 10 clients did not have an updated IPP on file which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 08/05/2024
Plan of Correction
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Licensee agrees to obtain an updated IPP for the 5 out of 10 clients and submit a copy of the IPP to the Fresno CCL office by the POC due date.
Type B
Section Cited
CCR
82069(a)
Client Medical Assessments
(a) Prior to or within 30 calendar days following the acceptance of a client, the licensee shall obtain a written medical assessment of the client that determines the licensee's ability to provide necessary health-related services to the client. The assessment shall be used in developing the Needs and Services Plan.

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 when 5 out of 10 clients did not have a medical assessment on file which poses a potential health, safety or personal rights risk to persons in care.
POC Due Date: 08/05/2024
Plan of Correction
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2
3
4
Licensee agrees to obtain an updated IPP for the 5 out of 10 clients and submit a copy of the medical assessments to the Fresno CCL office by the 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:Alexandria Walton
LICENSING EVALUATOR SIGNATURE:
DATE: 07/15/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/15/2024


LIC809 (FAS) - (06/04)
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