Routine inspection·April 13, 2022

On 04/13/2022, Licensing Program Analyst (LPA) Walton arrived unannounced to conduct an Annual Inspection - Infection Control. LPA introduced self, stated the purpose of the visit and requested to meet with the Administrator. Administrator was not present upon LPA's arrival, LPA spoke with Administrator, Lawrence Holland who gave LPA verbal permission to meet with Caregiver, Tiffany Owen. Administrator, Paulette Holland arrived a short time later. Facility has one central entry/exit. Facility tour conducted with Caregiver Owen. Social distancing is maintained in the common and dining areas. LPA checked residents’ locked medications and observed a 30-day supply. Food supply was checked, food was observed to be improperly stored. Cleaning and PPE supplies were checked. Facility has 3 shared bedrooms. Beds were observed to be at least 3 feet apart with head to toe orientation. In bedroom 1, LPA observed the fire exit to be blocked by a residents bed and a chair. Bathrooms toured. LPA did not observe hand washing signs and trash cans did have a lid. Staff records were reviewed for good health and infection control training. Facility staff was observed with mask on. Residents wear masks when away from the community. Resident’s files have updated emergency contact information. A deficiency is being cited in accordance with the California Code of Regulations, Title 22, Division 6, see attached 809D. CONTINUED TO 809C LPA is requesting the following documents be submitted to the Fresno CCL office by 04/27/2022 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 (LIC9020A), Surety Bond, and Mitigation Plan (LIC808). 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, Paulette Holland, whose signature on this form confirms receipt of this document.