Routine inspection·June 9, 2023

On 6/9/23, Licensing Program Analyst (LPA) M. Yang arrived unannounced to conduct an Annual Inspection visit. LPA introduced self, stated the purpose of the visit, and was greeted by caregiver Donte Gaynor. LPA was granted entry into the facility. Licensee/ Administrator Camalah Kopacz was called and stated unable to attend meeting. LPA toured facility with designee. All five resident were present upon LPA arrival. LPA conducted interviews with staff and resident. The tour started in the kitchen into the common areas, to the resident's bedrooms, and bathrooms. LPA observed COVID-19 related signs. The facility was observed to be at a comfortable temperature, clean, in good repair, and no passageway obstructions or fire hazards were observed inside or outside. Medications are kept locked in kitchen cabinet. MARs was review. An adequate supply of perishable and non-perishable food was observed. At approximately 11:30 AM, medication boxes were stored unlock in refrigerator unlock . Fire extinguisher was observed with a service date of: 06/02/23. Cleaning supplies and chemicals stored and locked in laundry room. LPA toured all resident’s bedrooms and observed 4 single occupant rooms. Residents’ room observed to be adequately furnished with bed, dresser, and adequate lighting. Bathrooms were properly equipped, and the hot water temperature was tested at 112.4 degrees F in bathroom 1 and range 111.4 to 111.6 degrees F in master bathroom. The exterior tour was conducted. Side gate was self-closing and self-latching. All residents’ file reviewed to have update emergency contacts and Admission agreement and Pre-Appraisal. Sample of staff's files were also reviewed. Staff files were observed to have current First Aid/CPR, Health screening, and Personnel record. Staff are fingerprinted clear and associated to the facility. Carbon monoxide and smoke detectors were tested and observed to be operational. A deficiency is being cited on the attached Lic 809D. Exit Interview conducted. The following documents are requested and submitted to Fresno CCL by: 6/15/23. The following updated forms were requested: Lic 308, Lic 500, Lic 610E, Lic 9282, current liability insurance, transportation procedure, theft and loss policy/procedure, and current Administrator certificate. A copy of this report and appeal rights was provided to Licensee/Administrator.