Routine inspection·October 13, 2021

On 10/13/2021, 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 the Administrator. LPA was met by Caregivers Bienvel Yap and MaryLena Javate. Arlene Bautista, Administrator was called by caregiver. Administrator states unable to meet with LPA and authorized caregiver Bienvel to received report and tour facility with LPA. All six residents were present during the inspection. LPA conducted tour with caregivers. Facility staffs was observed with mask on. Visitor log-in/temperature check was observed upon entry. Facility has one entrance/exit point. Facility appeared cleaned with no obstruction or fire clearance issues. Hand sanitizer was readily available to residents and visitors. Social distancing is maintained in the common and dining areas. LPA checked residents’ locked medications and observed a 30-day PPE supplies. Food supply was checked and appeared to be an adequate supply. LPA observed fire extinguishers with a service date of: 06/16/20. Cleaning supplies were stored and locked in garage cabinet and under kitchen sink. All bathrooms are observed with trash cans with lid and securely fastened grab bars. Bathrooms have non-skid mat. Hand washing posting by all sinks. Social distancing and cough etiquette postings observed in facility. All resident’s room toured and observed to be adequately furnished and lit. LPA observed 2 shared resident’s bedrooms to be at least 6 feet apart and 2 bedrooms that are single occupant. The exterior tour was conducted. Side gate was self-closing and self-latching. 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 updated forms were requested: LIC 308, LIC 500, LIC 610E, LIC 9020, current liability insurance, and updated Administrator Certificate. Please submit the above forms to Fresno CCL by: 10/19/21. Administrator and caregiver were informed that as COVID-19 precautionary measure, this report and appeal Rights were provided via email. Report signed on-site.