Routine inspection·February 4, 2022

On 02/04/22, Licensing Program Analyst (LPA) M. Yang arrived unannounced to conduct an Annual Inspection - Infection Control. LPA introduced self, stated the purpose of the visit, and requested to meet with administrator. LPA met with April Rose Salise and Monet Mark Sababo, caregiver. LPA toured facility with caregiver. Collin Murchison, designated representative was called and arrived shortly during tour. All six residents were present during the inspection. Upon entry facility staff was observed with no mask on. Visitor log-in/temperature check was observed upon entry. Hand sanitizer was readily available to residents and visitors. Facility has one entrance/exit point. Facility appeared cleaned with no obstruction or fire clearance issues. Social distancing is maintained in the common and dining areas. Social distancing and cough etiquette postings not observed. LPA checked residents’ locked medications. Per designated representative 30-day PPE supplies stored at facility central location. Food supply was checked and appeared to be an adequate supply. Cleaning supplies were stored and locked in cabinet in the garage and under kitchen sink. All bathrooms are observed with securely fastened grab bars and non-skid mat. All bathrooms observed trash bin with lid. LPA observed hand washing posting by all sinks. All resident’s room toured and observed to be adequately furnished and lit. LPA observed 6 bedrooms that are single occupant. The exterior tour was conducted. Side gate was self-closing and self-latching. LPA observed fire extinguisher served date: 01/22/21. Staff records were reviewed for good health and infection control training. All residents’ records reviewed to have updated emergency contact information. A deficiency is being cited on the attached 809D in accordance to California Code of Regulations, Title 22, Division 6. Exit Interview conducted. The following documents are requested and submitted to Fresno CCL by: 02/11/22. The following updated forms were requested: Lic 308, Lic 500, Lic 610E, Lic 808, and lease agreement. LPA received copy updated Lic 9020 during facility inspection. Designated representative was informed that as COVID-19 precautionary measure, this report and appeal rights will be provided via email. Report signed on-site.