Routine inspection·September 15, 2021

On 09/15/2021, Licensing Program Analysts (LPA) M. Yang and A. Walton arrived unannounced at the above facility to conduct an Annual Inspection- Infection Control. LPAs introduced self, stated the purpose of the visit and requested to meet with the Administrator. LPAs met with caregiver Modesta Paz. Caregiver call Administrator. Assistant Administrator Aurora Rigon arrived in a short time. LPAs conduct tour with Assistant Administrator . One resident was present during the tour. Visitor log-in/temperature check was observed upon entry. Facility has one entrance/exit point. Facility appeared cleaned with no obstruction or fire clearance issues. Hand sanitizer was readily available to residents and visitors. Social distancing is maintained in the common and dining areas. All bathrooms are observed with trash cans with lid and securely fastened grab bars. There are non-skid surfaces in the bathrooms. LPAs observed hand washing posting by all sinks. Bedrooms are single occupant. LPAs checked residents’ locked medications and observed a 30-day PPE supplies. Food supply was checked and there appeared to be an adequate supply. Staff records were reviewed for good health and infection control training. Facility staff was observed with mask on. LPAs reviewed 1 out of 2 residents have updated emergency contact information. Facility has not submitted LIC 808 Mitigation plan to CCL. Assistant Administrator agrees to submit LIC 808 to CCL by 9/21/21. Please submit the requested forms/information to Fresno CCL by: 09/28/21. The following updated forms were requested: LIC 308 Designation of Facility Responsibility, LIC 500 Personnel Report, LIC 610E Emergency Disaster Plan for Residential Care Facilities for The Elderly, LIC 9020 Register of Facility Clients/Residents, updated Liability Insurance, LIC 309 Administrative Organization, current Administrator Certification, current liability insurance, LIC 400 Affidavit Regarding Client/Resident Cash Resources, and LIC 402 Surety Bond. A deficiency is being cited on the attached 809D in accordance to California Code of Regulations, Title 22, Division 6. Exit interview was conducted and Plan of Correction was reviewed and developed with Assistant Administrator. Due to COVID-19 precautionary measures, a copy of this report and appeal rights will be provided via email and an electronic read receipt confirms receiving this email.