Routine inspection·May 21, 2025

On 5/21/2025, Licensing Program Analyst (LPA) J. Leffall arrived unannounced at the above facility to conduct an Annual Inspection. LPA introduced self, stated the purpose of the visit, and was granted entry to the facility by staff (S1) Pauline Simpson-Cox. Administrator (A1) Camalah Kopacz arrived shortly after LPA’s arrival. 3 residents were present during visit. LPA toured facility with S1. The facility was observed to be at a comfortable temperature, clean, in good repair, and no passageway obstructions or fire hazards were observed inside. An adequate supply of perishable and non-perishable food was observed. Samples of resident’s medications were observed locked in kitchen cabinet. Clients’ MARS was reviewed. 2 out of 3 residents medications were given but not initialed by staff. Fire extinguisher reviewed with a service date of: 5/18/25. Fire drill completed on 2/7/25. Clients' bedrooms were toured and reviewed. Cleaning chemicals were observed stored and locked in closet. Residents bedrooms observed to be adequately furnished with bed, dresser, and adequate lighting. All bathrooms are toured and observed to be operational. Hot water temperature was tested at a range of 108.6 to 115.8 degrees F in 2 bathrooms. Outside of facility toured. Outside observed free of debris. Side gate was self-closing and self-latching. Outside was observed with adequate outdoor seatings available for clients. Freezer temperature observed at -5 degrees F and refrigerator temperature maintained at 30 degrees F. Smoke detectors and carbon monoxide were tested and observed to be operational. All clients’ files and samples of staff’s files reviewed to have all the required documents. Continued on LIC-809C The following deficiency is being cited on the attached 809D in accordance with California Code of Regulations, Title 22, Division 6. Exit Interview conducted. LPA is requesting the following documents be submitted to the Fresno CCL office by 6/4/25: 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-RCFE) A copy of this report with appeal rights was provided to S1, whose signature on this form confirms receipt of this report.