Routine inspection·December 19, 2023

Licensing Program Analyst (LPA) Lissett Padgett arrived unannounced to conduct the Annual inspection. LPA was granted entry to the facility by Staff (S1). S1 called Administrator Sy Ly (AD) who arrived shortly thereafter and LPA explained the purpose of the visit. During this visit, LPA and AD toured the facility. The facility has a current census of 3. Resident rooms contained required furnishings and lighting. LPA observed required items in bathrooms with hot water measuring at 114.5 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 emergency food supply and paper products. Medications are centrally stored and locked in pantry. Doors and passageways are unobstructed throughout the facility including outdoors. Facility has two First Aid kits, they are located in the kitchen pantry and were found to contain required items. Sufficient supply of perishable and non-perishable food observed. Fire Extinguisher is located on kitchen counter and was serviced on 12/5/2023. Smoke and Carbon Monoxide detectors are tested and found to be operational. LPA conducted resident and staff file reviews and interviews. Technical violations are being cited in accordance with California Code of Regulations. 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 Administrator, whose signature on this form confirms receipt of these documents. LPA is requesting the following documents be submitted to the Fresno CCL office by 12/29/23:Copy of property grant deed, 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 .