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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157206591
Report Date: 10/28/2021
Date Signed: 10/28/2021 02:44:41 PM

Document Has Been Signed on 10/28/2021 02:44 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 CAREFACILITY NUMBER:
157206591
ADMINISTRATOR:YATCO, JERRYFACILITY TYPE:
740
ADDRESS:8306 SHIPROCK DRIVETELEPHONE:
(661) 587-0370
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93312
CAPACITY: 6CENSUS: 6DATE:
10/28/2021
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:42 AM
MET WITH:Administrator, Jasmin YatcoTIME COMPLETED:
11:30 AM
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Licensing Program Analyst (LPA) Darius Wiliams conducted an unannounced Annual Visit inspection. LPA Williams met with Administrator, Jasmin Yatco, and discussed the purpose of the visit.

LPA Williams toured the facility.

LPA Williams observed a visitor log/temperature check, masks, and disinfection station at the front entrance. Facility has one entry and exit point. Hand sanitizer was readily available to residents and visitors. Social distancing is maintained in the common areas. Hand washing signs were observed in the bathrooms. LPA Williams advised the Administrator to hang following signs in the common areas; cough etiquette, recognizing symptoms, and physical distancing.

LPA Williams observed a two day supply of perishable food and seven day supply of non-perishable food. Cleaning supplies and medications were observed behind a locked door. LPA Williams observed the following personal protective equipment in storage; gown,gloves, and masks. Administrator has access to face shields at a offsite location.

LPA Williams observed staff training records regarding Covid-19 mitigation and infection control. LPA Williams observed all facility staff wearing masks. Resident’s files have updated emergency contact information.

No deficiencies were cited.

LPA Williams requested the following documents be sent to the Department by 11/4/2021; Personnel Report (LIC 500), Designation of facility (LIC 309), and Administrator Certificate.

Exit interview was conducted and a copy of this report was provided.
SUPERVISORS NAME: Serigy Pidgirny
LICENSING EVALUATOR NAME: Darius Williams
LICENSING EVALUATOR SIGNATURE: DATE: 10/28/2021
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 10/28/2021
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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