Routine inspection·November 3, 2022

On 11/03/22, Licensing Program Analyst (LPA) V Gorban unannounced Annual Required Infection Control Inspection. LPA observed a central entry point with a supply of hand sanitizer located upon entry. A sign in policy that includes documented routine symptom screening for visitors is currently being implemented to follow current visitation guidelines. LPA introduced self and stated purpose of visit , LPA met with Marez Phoeun, Administrator Certificate #6031818740, expires 06/13/24. Facility toured with Administrator. All six private bedrooms are single occupancy, fully furnished, some bedrooms share walk in showers and bathrooms. Residents present during today's inspection observed to be sitting in dining/activity areas after lunch watching a television and others resting in their bedroom. Kitchen toured, LPA observed facility to have a 2-day of perishable and a 7-day supply of non-perishable food available. Medications are locked and secured in medication room, residents observed to have a 30-day supply of medication available. PPE is locked and secured and available if necessary. Carbon Monoxide detectors observed to be operational during today's inspection. Fire extinguishers present with a service date of 07/20/22. Deficiencies observed, licensee did not pay annual fees, and documented on D form. Exit interview conducted. Report signed on site and a copy provided to Administrator for facility records. Community Care Licensing (CCL) is always striving to have facility files that reflect the most accurate & up to date information for your facility. In an effort to maintain your facility file, please submit the most current & complete forms &/or information as identified below: Residential Care Facility for the Elderly (RCFE): · LIC 308 Designation of Facility Responsibility · -as applicable: LIC 309 Administrative Organization · -as applicable: LIC 400 Affidavit Regarding Client/Resident Cash Resources · -as applicable: LIC 402 Surety Bond · LIC 500 Personnel Report · LIC 610E Emergency Disaster Plan For Residential Care Facilities For The Elderly · LIC 9020 Register of Facility Clients/Residents · Copy of current Liability Insurance · Copy of current Administrator Certificate · Alternate contact information including name, telephone number, & email address. Please submit the above forms/information to Fresno CCL by: 11/25/2022 As an operator of a Community Care Licensed facility it is your responsibility to be aware of and in compliance with all regulations, including Chaptered Legislation. Go to www.ccld.ca.gov to stay updated and informed.