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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157208254
Report Date: 12/28/2021
Date Signed: 01/03/2022 03:41:00 PM

Document Has Been Signed on 01/03/2022 03:41 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:ADAKCFACILITY NUMBER:
157208254
ADMINISTRATOR:CAPRA, JANETTEFACILITY TYPE:
775
ADDRESS:4203 BUENA VISTA RDTELEPHONE:
(661) 665-8871
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93311
CAPACITY: 100CENSUS: 18DATE:
12/28/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
01:22 PM
MET WITH:Julie Juarez-Ceja, Community Relations DirectorTIME COMPLETED:
02:30 PM
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On this day, Licensing Program Analyst (LPA) L. Salazar arrived at the Day Program unannounced to conduct the Infection Control Inspection. LPA met with Community Relations Director CRD). LPA completed the Covid Contact questionnaire prior to entrance into the facility. Upon entry, LPA’s temperature and symptom screening was conducted by staff. LPA entered through the central entry point where hand sanitizer, visitor sign in and screening policy was observed. CDSS Provider Information Notifications (PINS) were observed in the lobby in a binder.

Facility Mitigation plan has been received and added to facility file. Infection control procedures described in the plan which were observed or reviewed by LPA during the visit include: Daily symptoms screenings (for staff, persons in care and visitors),visitation policy, quarantine/isolation procedures, infection control and disinfecting procedures that include a designated person to disinfect every touch point, staffing plan, Personal Protection Equipment (PPE) storage and use, infection control training, communication procedures. Administrator and CRD are identified as the Infection Control Leads for the program.

LPA toured the facility inside. Required postings such as hand washing, coughing etiquette and physical distancing were observed in the facility. Day program prepares meals for clients in the cafe. LPA observed a supply of fresh food in the designated kitchen. Meals include Breakfast, Lunch and afternoon snack. Dining area was set for 2 clients to sit at the end of each 6ft table. Staff were all observed wearing face coverings. LPA observed 30-day PPE supply. Sinks observed to be stocked with liquid soap, paper towels and covered trash cans in restrooms. Through LPA’s observations and interview with CMD, the required infection control practices are found to be in compliance. No deficiencies cited on today’s inspection.
SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Lisa Salazar
LICENSING EVALUATOR SIGNATURE: DATE: 12/28/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 12/28/2021
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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