Routine inspection·January 12, 2024

Licensing Program Analyst (LPA) Lissett Padgett arrived unannounced to conduct the Annual inspection. LPA met with Administrator Raul Tiburcio (AD) and explained the purpose of the visit. Facility was toured with AD. During this visit, LPA toured the facility inside & out. Resident rooms contained required furnishings and lighting in 3 of the 4 bedrooms. LPA is requesting an AD submit and exception for furniture not available in R1’s bedroom. LPA observed required items in two resident bathrooms with hot water measuring 109.1 and 116.8 degrees F. Resident hygiene supplies were properly stored and available. The kitchen was toured observed in good repair with necessary items and appliances and sharps/knives were properly stored. LPA observed required food supply and paper products. Medications are centrally stored and locked. Facility has designated visitation areas available inside and out. Doors and passageways are unobstructed throughout the facility including outdoors, gate was found to be in working order. First aid kit located in locked cabinet in kitchen and found to contain required items. Fire Extinguisher located in the kitchen was serviced on 7/6/2023. Smoke and Carbon Monoxide detectors are tested found to be operational. LPA conducted resident and staff file reviews and interviews. Administrator’s re-certification was confirmed to be in active status. Deficiencies are being cited in accordance with California Code of Regulations on the attached LIC 809-D. An exit interview was conducted and a Plan of Correction was developed. A copy of this report and Appeal Rights were discussed and left with AD, whose signature on this form confirms receipt of these documents. LPA is requesting the following documents be submitted to the Fresno CCL office by 1/19/2024: 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) , Exemption Request Letter , staff training verification .