Routine inspection·October 21, 2022

On 10/21/2022, Licensing Program Analysts (LPAs) V. Gorban and Sarah Hurt arrived unannounced at the above facility to conduct an Annual Inspection- Infection Control. LPA introduced selves, stated the purpose of the visit, and was granted entry to the facility by Administrator, LA Shay Ayers. Visitor log-in/temperature check station was observed upon entry. Hand sanitizer was readily available to residents and visitors. Facility has one entrance/exit point. Hand washing and other various Covid-19 related signs were observed in the common areas. Facility staff was observed with mask covering. The facility was observed to be at a comfortable temperature, free of debris, in good repair, and no passageway obstructions or fire hazards were observed. Common areas were properly furnished and well-lit throughout . PPE observed by facility entrance. A 2-day supply of perishable and 7-day supply of non-perishable food was observed to be properly stored. Fire extinguisher was observed with a purchase date of: 07/13/2022. Resident's Bedrooms were observed to be adequately furnished with bed, dresser, and adequate lighting. Sample of residents file was reviewed for emergency contact. LPA's confirmed facility staff present is background cleared. LPA's confirmed facility staff has COVID 19 vaccine cards or exemptions on file. LPA's observed a hallway closet with cleaning supplies, and bleach unlocked and accessible to residents. Continued to LIC809 C LPAs are requesting the following documents to be provided to the Fresno CCL office by 10/31/2022: Current copy of Administrator Certificate, Designation of Facility Responsibility (LIC308), Emergency and Disaster Plan (LIC610D) , Personnel Report (LIC500). LIC 308 Designation of Facility Responsibility · -as applicable: LIC 309 Administrative Organization · -as applicable: LIC 400 Affidavit Regarding Client/Resident Cash Resources · -as applicable: LIC 402 Surety Bond · LIC 500 Personnel Report · LIC 610E Emergency Disaster Plan For Residential Care Facilities For The Elderly · LIC 9020 Register of Facility Clients/Residents · Copy of current Liability Insurance · Copy of current Administrator Certificate · Alternate contact information including name, telephone number, & email address. The following deficiency is being cited today Per Title 22 Regulations. An exit interview was conducted with Administrator. Report signed on-site by Administrator and printed copy provided.