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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157208810
Report Date: 10/21/2024
Date Signed: 10/21/2024 04:54:28 PM

Document Has Been Signed on 10/21/2024 04:54 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
SIERRA CASCADE AC/SC, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME:COLE VOCATIONAL SERVICES BAKERSFIELD 2FACILITY NUMBER:
157208810
ADMINISTRATOR/
DIRECTOR:		MADKINS, JEANETTEFACILITY TYPE:
775
ADDRESS:5101 MING AVETELEPHONE:
(661) 834-8700
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93309
CAPACITY: 75CENSUS: 54DATE:
10/21/2024
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME VISIT/
INSPECTION BEGAN:
10:16 AM
MET WITH:Program Director Jaenette Madkins and Area Director Hanh MirelesTIME VISIT/
INSPECTION COMPLETED:
05:15 PM
NARRATIVE
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Licensing Program Analyst (LPA) K. Kaur conducted an unannounced Annual inspection visit. LPA met with Program Director Jaenette Madkins and Area Director Hanh Mireles, and discussed the purpose of the visit.

LPA and the Program Director toured the facility together. Facility is maintained at a comfortable temperature. LPA observed adequate seating and lighting throughout the facility. No passageway obstructions or hazards were observed inside or outside. Client restrooms were toured, observed to be clean, and operational with adaptive devices. Facility dining area was toured. Clients bring their own lunches to program. Locked cubbies were observed in several areas. Cleaning supplies were observed behind locked door, in a storage room. LPA toured the rest area for quiet space. At 1:09 PM LPA observed Fire extinguishers was expired with a service date of 10/8/2023.

LPA observed clients in various rooms eating and participating in various activities; puzzles, games, watching favorite shows, and styling class. Staff were present in each activity room actively supervising and engaging with clients.

Client’s records contained signed Admission Agreement, Personal Rights, and TB clearance. LPA observed 4 out of 5 residents did not have medical assessments. Medical Progress notes were observed from examinations; however, did not have the required information. LPA observed 1 client had a IPP that was dated 2022. Staff files were reviewed for good health. It was verified that current staff on duty are CPR certified. Last Fire Drill conducted on 8/23/2024. During Medication review, LPA discovered a R1’s Medication count was short by 1 pill. Centrally Stored Medication Destruction Record (CSMDR) was marked with a start date of 10/1/2024. Per interview with Program Director 1 pill was given for the previous month.

Continued to 809-C
SUPERVISORS NAME: See Moua
LICENSING EVALUATOR NAME: Kamaldeep Kaur
LICENSING EVALUATOR SIGNATURE: DATE: 10/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/21/2024
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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Document Has Been Signed on 10/21/2024 04:54 PM - It Cannot Be Edited


Created By: Kamaldeep Kaur On 10/21/2024 at 03:34 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: COLE VOCATIONAL SERVICES BAKERSFIELD 2
FACILITY NUMBER: 157208810

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/21/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
82070(b)(8)
Client Records
(b) Each record must contain information including, but not limited to, the following: (8) Medical assessment, including ambulatory status, as specified in Section 82069(b).

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview, and record review, the licensee did not comply with the section cited above in 4 out of 5 clients did not have physician’s Report LIC 602. Progress notes were available but did not have the required information which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 10/22/2024
Plan of Correction
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Program Director agrees to obtain Physician’s Reports (LIC 602) from residential facilities and request clients that are home based to schedule doctor appointments to get medical assessments completed.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:See Moua
LICENSING EVALUATOR NAME:Kamaldeep Kaur
LICENSING EVALUATOR SIGNATURE:
DATE: 10/21/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/21/2024


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 10/21/2024 04:54 PM - It Cannot Be Edited


Created By: Kamaldeep Kaur On 10/21/2024 at 03:34 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: COLE VOCATIONAL SERVICES BAKERSFIELD 2
FACILITY NUMBER: 157208810

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/21/2024

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 observation, interview, and record review, the licensee did not comply with the section cited above in 1 out of 5 clients had a IPP that was two years old which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 10/28/2024
Plan of Correction
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Program Director agrees to obtain IPP from CVRC or complete a Appraisal Needs and service plan by the due date.
Type B
Section Cited
CCR
82075(b)
Health-Related Services
(b) Clients shall be assisted as needed with self-administration of prescription and nonprescription medications.

This requirement is not met as evidenced by:
Deficient Practice Statement
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Based on observation, interview, and record review, the licensee did not comply with the section cited above in 1 out of 2 clients medicaiton count was short by 1 pill which poses/posed a potential health, safety or personal rights risk to persons in care.
POC Due Date: 10/28/2024
Plan of Correction
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Program Director to complete an in service training regarding medication and submit documentation when completed.
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:See Moua
LICENSING EVALUATOR NAME:Kamaldeep Kaur
LICENSING EVALUATOR SIGNATURE:
DATE: 10/21/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/21/2024


LIC809 (FAS) - (06/04)
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Document Has Been Signed on 10/21/2024 04:54 PM - It Cannot Be Edited


Created By: Kamaldeep Kaur On 10/21/2024 at 03:44 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: COLE VOCATIONAL SERVICES BAKERSFIELD 2
FACILITY NUMBER: 157208810

DEFICIENCY INFORMATION FOR THIS PAGE:
VISIT DATE: 10/21/2024

DEFICIENCIES & PLANS OF CORRECTION (POCs)
Type A
Section Cited
CCR
82064(c)(6)


82064 Administrator - Qualifications and Duties (c) In addition to the requirements in Section 82064(a), the administrator shall: (6) Comply with applicable laws and regulations.
Deficient Practice Statement
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Based on observation, and record review, the licensee did not comply with the section cited above in 3 out of 3 fire extinguishers were expired with a service date of 10/9/2023 which poses an immediate health, safety or personal rights risk to persons in care.
POC Due Date: 10/22/2024
Plan of Correction
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Program Director agress the fire extinguisher will be replaced or serviced with a current date. Proof of correction will be submitted to the CCL office by the due date.
Section Cited
Deficient Practice Statement
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POC Due Date:
Plan of Correction
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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:See Moua
LICENSING EVALUATOR NAME:Kamaldeep Kaur
LICENSING EVALUATOR SIGNATURE:
DATE: 10/21/2024
I acknowledge receipt of this form and understand my appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 10/21/2024


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STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
SIERRA CASCADE AC/SC, 1314 E SHAW AVE
FRESNO, CA 93710
FACILITY NAME: COLE VOCATIONAL SERVICES BAKERSFIELD 2
FACILITY NUMBER: 157208810
VISIT DATE: 10/21/2024
NARRATIVE
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Deficiency is being cited on the attached 809D in accordance with California Code of Regulations, Title 22, Division 6.

The following documents are requested and need to be submitted to Fresno CCL office by 10/28/2024: Current copy of Administrator Certificate, Designation of Facility Responsibility (LIC308), Administrator Organization (LIC 309), Affidavit regarding Client/Resident Cash Resources (LIC 400), Emergency and Disaster Plan (LIC610D), Personnel Report (LIC500), Register of Facility Clients/Residents LIC9020.

An exit interview was conducted with the Program Director. Report signed on-site; a copy of this report, 809D with appeal rights were provided.
SUPERVISORS NAME: See Moua
LICENSING EVALUATOR NAME: Kamaldeep Kaur
LICENSING EVALUATOR SIGNATURE:

DATE: 10/21/2024
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 10/21/2024
LIC809 (FAS) - (06/04)
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