<meta name="robots" content="noindex">
Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 157208941
Report Date: 03/23/2023
Date Signed: 03/23/2023 01:02:10 PM

Document Has Been Signed on 03/23/2023 01:02 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 CARE IVFACILITY NUMBER:
157208941
ADMINISTRATOR:YATCO, JASMINFACILITY TYPE:
740
ADDRESS:13511 HINAULT DRTELEPHONE:
(661) 615-3312
CITY:BAKERSFIELDSTATE: CAZIP CODE:
93314
CAPACITY: 6CENSUS: 6DATE:
03/23/2023
TYPE OF VISIT:Required - 1 YearUNANNOUNCEDTIME BEGAN:
10:20 AM
MET WITH:Licensee, Jerry YatcoTIME COMPLETED:
01:16 PM
NARRATIVE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
On 03/23/2023, Licensing Program Analyst (LPA) Walton arrived unannounced to conduct an annual inspection. LPA introduced self and requested to meet with the Administrator. Facility staff contacted Administrator via telephone. Licensee, Jerry Yatco arrived a short time later. LPA disclosed the purpose of the visit with Licensee.

LPA conducted a tour inside and outside of facility. Facility observed to be clean, odor free and at a comfortable temperature. Common areas were furnished well with adequate seating and lighting available. Resident rooms appeared clean and had required furnishings. LPA observed an adequate supply of linen. Resident bathrooms were properly equipped with securely fastened grab bars in toilet and tub/shower areas, non-skid mats were observed. Hot water measure at 108.7 degrees F and 108.4 degrees F. Kitchen toured, appeared clean, observed a 7-day supply of non-perishable and 2-day supply of perishable food. Exterior tour conducted, all exits open and free of obstructions. Side gate was observed to be self-latching.

Fire extinguisher serviced on 06/20/2022. Smoke detectors and carbon monoxide detectors observed operational during today’s inspection. Cleaning supplies are locked in secured under kitchen sink. LPA reviewed staff and client records. Medications reviewed and observed to have original labels and be administered as prescribed.

LPA is requesting the following documents be submitted to the Fresno CCL office by 04/06/2023: Current copy of Administrator Certificate, Designation of Facility Responsibility (LIC308), Administrator Organization (LIC 309), Affidavit regarding Client/Resident Cash Resources (LIC 400), Liability Insurance, Emergency and Disaster Plan (LIC 610E) ersonnel Report (LIC500), Register of Facility Clients/Residents for LIC9020A), Surety Bond.

No deficiencies issued. Exit interview conducted. A copy of this report was discussed and provided to Licensee, Jerry Yatco, whose signature on this form confirms receipt of this document.

SUPERVISORS NAME: Melinda Hoffmann
LICENSING EVALUATOR NAME: Alexandria Walton
LICENSING EVALUATOR SIGNATURE: DATE: 03/23/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE: DATE: 03/23/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
Page: 1 of 1