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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157206922
Report Date: 07/21/2023
Date Signed: 07/21/2023 09:53:19 PM


Document Has Been Signed on 07/21/2023 09:53 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: 5DATE:
07/21/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:40 PM
MET WITH:Jasmine YatcoTIME COMPLETED:
04:00 PM
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On 07/21/23, Licensing Program Analyst (LPA) M. Medina arrived to the facility unannounced to conduct the required Annual Inspection Visit. LPA was greeted by Administrator, stated the purpose of the visit and was allowed entry into the facility.

A tour of resident bedrooms were observed to have the required lighting and furnishings. Bathrooms were toured and observed to have operational lights, running water, and non- slip mats, and grab bars in showers and near toilets. Hot water temperature measured at 106 degrees F. LPA toured the kitchen observed the required 7-day supply of non-perishable food and 2- day supply of fresh perishables to be properly stored. Medications were observed to be locked, secured and inaccessible to residents.

Smoke detector/carbon monoxide detectors were observed to be operational. Fire Extinguishers observed to have a purchase date of 1/5/2023. First Aid kit observed to contain all required items.

The following documents are requested to be updated and submitted to Fresno CCL by: 8/04/23: LIC 500, LIC 610, and Certificate of Liability Insurance.

LPA Medina reviewed resident and staff files during facility inspection.



An exit interview was conducted with Administrator. A copy of this report was discussed and provided at the time of visit.

No deficiencies cited on today's visit.

SUPERVISOR'S NAME: Melinda HoffmannTELEPHONE: (559) 341-3247
LICENSING EVALUATOR NAME: Melinda MedinaTELEPHONE: (559) 410-5914
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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