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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157208254
Report Date: 11/10/2022
Date Signed: 11/10/2022 10:41:08 AM

Document Has Been Signed on 11/10/2022 10:41 AM - 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, JANELLEFACILITY TYPE:
775
ADDRESS:4203 BUENA VISTA RDTELEPHONE:
(661) 665-8871
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93311
CAPACITY: 100CENSUS: 30DATE:
11/10/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
09:33 AM
MET WITH:Janelle Capra, Administrator and Julie Juarez-Ceja, Director of ProgramsTIME COMPLETED:
10:50 AM
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On 11/10/22, Licensing Program Analyst (LPA) M. Yang arrived unannounced to conduct an Annual Inspection - Infection Control. LPA met Janelle Capra, Administrator and Julie Juarez-Ceja, Director of Programs. 18 clients were present during the inspection. LPA completed a tour of the facility with Administrator and Director of Programs.

Upon entry staff was observed with no facial covering. Visitor log-in/temperature check was observed at entry. Hand sanitizer was readily available to clients and visitors. Social distancing is maintained in the common areas. LPA observed social distancing and cough etiquette postings in facility. Day program prepares meals for clients in the cafe. Meals include Breakfast, Lunch and afternoon snack. Client restrooms were tour, observed to be clean, and operational. LPA observed hand washing posting by sinks. LPA observed 30-day PPE supply.

The Day Program has group activities that are maintained 6 feet apart. Facility is maintained at a comfortable temperature and no passageway obstructions or fire hazards were observed. LPA observed locked medications in locked locker in Program Manager office.

A sample of client files were also reviewed to have updated emergency contact information. Staff files have current 1st Aid and infection control training.

No deficiency observed.

Exit Interview conducted. The following documents are requested and to be submitted to Fresno CCL by: 11/16/22. The following updated forms were requested: Lic 308, Lic 500, Lic 610D and Lic 9282. A copy of this report was provided to the Administrator and Director of Programs

SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Mai Yang
LICENSING EVALUATOR SIGNATURE: DATE: 11/10/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/10/2022
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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