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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157206591
Report Date: 11/28/2022
Date Signed: 11/28/2022 04:55:50 PM

Document Has Been Signed on 11/28/2022 04:55 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: 5DATE:
11/28/2022
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
12:10 PM
MET WITH:Jerry YatcoTIME COMPLETED:
02:02 PM
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On 11/28/2022, Licensing Program Analyst (LPA) M. Medina conducted an Annual Required Infection Control Inspection. LPA Medina met by Licensee, Jerry Yatco and stated the purpose of the facility visit. COVID-19 guidelines are in place. Visitor log-in/temperature check was observed upon entry.

Tour of the facility conducted. Facility appeared cleaned with no obstruction or fire clearance issues. Hand sanitizer was readily available to residents and visitor. Resident bedrooms toured, facility has 1 shared bedroom and 4 private bedrooms. Resident bedroom that is shared has a minimum of 6 feet between beds.

LPA checked residents’ medications and observed a 30-day supply. LPA observed a 2-day supply of perishable and a 7-day supply of non-perishable food available. Cleaning supplies are locked and secured. Facility has PPE supplies available. Fire extinguisher present with a service date of 1/04/2022. LPA observed carbon monoxide detectors and smoke detectors to be operational during today's inspection.

Outside of facility toured, all exits open freely and no obstructions observed.

Exit interview was conducted. Facility report signed on site and a copy provided to Administrator for facility records.

No deficiencies issued during inspection.
SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Melinda Medina
LICENSING EVALUATOR SIGNATURE: DATE: 11/28/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 11/28/2022
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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