Routine inspection·October 27, 2021

On 10/27/2021, 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 met with caregiver Latoya Holland. Caregiver call Administrator Lawrence Holland and Licensee Paulette Holland. LPA conduct tour with caregiver. Administrator and Licensee arrived later during tour. Four residents were present during the inspection. Facility staff was observed with mask on. Visitor log-in/temperature check was observed upon entry. Hand sanitizer was readily available to residents and visitors. Social distancing is maintained in the common and dining areas. Social distancing postings in facility. Cough etiquette postings were not observed in facility. Facility has one entrance/exit point. Facility appeared cleaned with no obstruction or fire clearance issues. LPA checked residents’ locked medications. A 30-day PPE supplies were not observed. LPA observed a bleach bottle under unlocked kitchen sink. Food supply was checked and appeared to be an adequate supply. LPA observed a paint can and laundry detergent unsecured and unlocked in garage cabinet. All bathrooms are observed with trash cans with lid and securely fastened grab bars. Bathrooms have non-skid mat. No hand washing sign by bathroom sinks. LPA observed a bleach bottle in unlock hall cabinet. 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 1 bedroom that are single occupant. The exterior tour was conducted. Side gate was self-closing and self-latching. LPA observed fire extinguisher serviced date: 10/27/20. 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 was conducted. A plan of correction was developed and reviewed with the administrator. The following documents are requested and submitted to Fresno CCL by: 11/2/21. The following updated forms were requested: Lic 308, Lic 309, Lic 500, and Lic 9020. LPA received copy of updated Lic 610E during facility inspection. Administrator was informed that as COVID-19 precautionary measure, this report will be provided via email. Report signed on-site.