Routine inspection·June 29, 2022

On 06/29/2022, Licensing Program Analyst (LPA) Walton arrived unannounced to conduct an annual inspection. LPA introduced self, stated the purpose of the visit and requested to meet with the Administrator. LPA met with Administrator (ADM), Irina Chernyakova. Facility has one central entry and exit. Facility has implemented a sign-in policy for visitors. Facility tour conducted with ADM. All pathways, entrances and exits were clear from obstructions. No fire clearance issues. LPA observed signs promoting hand-washing, social distancing, and cough/sneeze etiquette. Facility staff were not observed wearing facial coverings. LPA toured the facility kitchen. LPA observed a knife on the kitchen counter accessible to residents in care. LPA observed a 7-day supply of non-perishable foods and a 2-day supply of perishable foods. LPA observed a 30 day supply of PPE and cleaning supplies. Residents at the above facility have private rooms. Facility bathrooms were stocked with paper towels and liquid soap. Hand-washing signs observed in resident bathrooms. LPA observed disinfectant wipes accessible to residents in care in 3 out of 3 bathrooms. LPA observed cleaning supplies/solutions, accessible to residents in care under the sink in bathrooms 1 and 2. LPA checked residents' medication and observed a 30 day supply. Resident temperature checks are documented daily. Resident records have updated emergency contact information. Facility staff records reviewed for good health. Based on observation, a deficiency is being cited in accordance with to California Code of Regulations, Title 22, Division 6. CONTINUED TO 809C LPA is requesting the following documents be submitted to the Fresno CCL office by 07/13/2022: Infection Control Plan, 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), Personnel Report (LIC500), Register of Facility Clients/Residents for (LIC9020) (LIC9020A) and Surety Bond. Exit interview conducted and a Plan of Correction was reviewed and developed with Administrator. A copy of this report and appeal rights were discussed and provided to Administrator, Irina Chernyakova, whose signature on this form confirms receipt of this document.