Routine inspection·December 13, 2022

On 12/13/2022, Licensing Program Analyst (LPA) K.Kaur arrived unannounced to conduct an Annual Inspection - Infection Control. LPA introduced self, stated the purpose of the visit and requested to meet with Administrator. LPA was allowed entry by caregiver Crystal Brieske. Licensee Paulette Holland was contacted. Visitor log-in/temperature check, masks, and disinfection station were observed upon entry. Facility has one entrance/exit point. Facility staff observed without facial coverings. Facility appeared clean and obstruction or fire clearance issues. Hand sanitizer was readily available to residents and visitors. Hand washing and other various Covid-19 related signs were observed in the common areas. At 12:20 PM LPA observed the Fire extinguisher to be expired with a service date of 10/28/2021 in the Kitchen. All bathrooms observed with trash cans that have lids, and securely fastened grab bars. Bathrooms have non-skid mats. All resident’s rooms toured and observed to be adequately furnished and lit. LPA observed 3 shared resident’s bedrooms. 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. LPA checked residents’ locked medications. 30-day PPE supplies observed . Food supply was checked and appeared to be an adequate supply. A deficiency is being cited on the attached 809D in accordance to California Code of Regulations, Title 22, Division 6. LPA is requesting the following documents be submitted to the Fresno CCL office by 12/23/2022: Current copy of Administrator Certificate, Designation of Facility Responsibility (LIC308), Administrator Organization (LIC 309), Affidavit regarding Client/Resident Cash Resources (LIC 400), Emergency and Disaster Plan, Personnel Report (LIC500), Register of Facility Clients/Residents for LIC9020. An exit interview was conducted with Licensee. Report signed on-site by licensee; a copy of this report, appeal rights and printed provided