Routine inspection·August 19, 2024

On 08/19/24 Licensing Program Analysts (LPA) L. Xiong and J. Leffall arrived unannounced to conduct an Annual Inspection. LPAs introduced selves, stated the purpose of the visit, and was greeted by Administrator (A1) Alex Babakhani. LPAs were granted entry. 2 clients were present during inspection. LPAs toured facility with A1. 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. Freezer temperature was maintained at 0 degrees F and refrigerator temperature was maintained at 37 degrees F. Cleaning chemicals were observed stored and locked under kitchen sink. Fire extinguisher was observed with a service date of: 04/11/24. Fire drill last completed on 08/7/24. Clients' bedrooms were toured and 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 118.9 degrees F. in bathroom 1 and in bathroom 2. Outside of facility toured. Side gate was self-closing and self-latching. Outside was observed with adequate outdoor seatings available for clients. Medications were checked and observed kept locked in medication cart. Clients’ MARS was reviewed. Medication Fludrocortisone .1 MG tablets, Dosage Instructions: 1 tablet per day, daily. Instructions were written in Mars by staff and not by the Dr. or Pharmacy. Carbon monoxide and smoke detectors were tested and observed to be operational. All clients’ file reviewed to have all the required documents. A sample of staff files and all clients’ files were reviewed and observed to have all the required documents. The following deficiencies were cited: Incidental Medical and Dental - Type A: 87465(c)(2) - Dr's direction states on prescription label for medication to be given one tablet daily and not as needed. LPA's observed hand written medication instructions by staff and not by Pharmacy or Dr. Exit Interview conducted. The following documents requested to be updated and submitted to Fresno CCL by 08/31/24: Lic 308, Lic 500, Lic 610D, and Lic 9020. LPA received a copy of current Administrator certificate. A copy of this report was provided to Administrator, whose signature on this form confirms receipt of these report.