Routine inspection·March 24, 2023

On 03/24/2023, 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. Facility staff contacted Licensee, Paulette Holland, via telephone who arrived a short time later. LPA disclosed the purpose of the visit with the Licensee Paulette Holland. 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. LPA observed the water pressure for the sink in bathroom two to be low preventing an adequate flow of hot water. Hot water measured at 128.7 degrees F. in bathroom 1. Kitchen toured, appeared clean. LPA observed an adequate supply of food. Exterior tour conducted, all exits open and free of obstructions. Fire extinguisher serviced on 12/13/2022. Smoke detectors and carbon monoxide detectors observed operational during today’s inspection. All cleaning supplies are locked in secured under kitchen sink. LPA reviewed staff and client records. Medications reviewed and observed to have original labels. Upon review of records, LPA found that facility staff did not administer medications to 2 out of 6 residents due to medications needing to be refilled. LPA observed the first aid kit was not up to date. LPA is requesting the following documents be submitted to the Fresno CCL office by 04/07/2023: 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) Personnel Report (LIC500), Register of Facility Clients/Residents for (LIC9020A), Surety Bond. CONTINUED TO 809C. Deficiencies are being issued in accordance to California Code of Regulations, Tittle 22, Division 6 on the attached 809D. Exit interview conducted and a plan of correction was reviewed and developed with Licensee. A copy of this report and appeal rights were discussed and provided to Licensee, whose signature on this form confirms receipt of this document.