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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157206922
Report Date: 07/20/2022
Date Signed: 07/20/2022 12:26:28 PM


Document Has Been Signed on 07/20/2022 12:26 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:ARCADIA FAMILY CARE IIIFACILITY NUMBER:
157206922
ADMINISTRATOR:YATCO, JASMINEFACILITY TYPE:
740
ADDRESS:10615 TROPHY CTTELEPHONE:
(661) 588-1483
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93312
CAPACITY:6CENSUS: 6DATE:
07/20/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:35 AM
MET WITH:Jerry Yatco
Jasmine Yatco		TIME COMPLETED:
12:45 PM
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On 7/20/2022, Licensing Program Analyst (LPA) M. Medina conducted an Annual Required Infection Control Inspection. LPA Medina met by Licensee, Jerry Yatco and stated the purpose of the facility visit. COVID-19 guidelines are in place. Visitor log-in/temperature check was observed upon entry. Jasmine Yatco serves as facility Administrator, Certificate #6016639740, expires 5/23/2024

Tour of the facility conducted. Facility appeared cleaned with no obstruction or fire clearance issues. Hand sanitizer was readily available to residents and visitor. Resident bedrooms toured, resident bedrooms have a minimum of 6 feet between beds.

LPA checked residents’ medications and observed a 30-day supply. LPA observed a 2-day supply of perishable and a 7-day supply of non-perishable food available. Cleaning and PPE supplies are locked and secured under kitchen sink. Fire extinguisher present with a service date of 1/04/2022. LPA observed carbon monoxide detectors and smoke detectors to be operational during today's inspection.

Facility COVID training records reviewed.

Exit interview was conducted. Facility report signed on site and a copy provided to Administrator for facility records.

No deficiencies issued during inspection.
SUPERVISOR'S NAME: Melinda HoffmannTELEPHONE: (559) 341-3247
LICENSING EVALUATOR NAME: Melinda MedinaTELEPHONE: (559) 410-5914
LICENSING EVALUATOR SIGNATURE:
DATE: 07/20/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 07/20/2022
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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