Routine inspection·January 3, 2024

This document was recreated due to replication error which did not record the original document. The copy of the original LIC809 with signatures is on file. Licensing Program Analyst, L. Padgett (LPA) arrived unannounced to conduct the Annual inspection. LPA met with Administrator DeAngela Santos (AD) and explained the purpose of the visit. The Facility was toured with AD. Facility observed to be clean, odor free and at a comfortable temperature. Common areas were furnished well with adequate seating and lighting available. Resident rooms appeared clean and had required furnishings. LPA observed an adequate supply of linen. Resident bathrooms were properly equipped with securely fastened grab bars in toilet and tub/shower areas, non-skid strips were observed in both showers. Hot water measure at 125.4 and 131.1 degrees F, AD posted warning signs above sinks during this inspection and also lowered the temperature on the water heater during this visit. Kitchen toured, appeared clean, observed a 7-day supply of non-perishable and 2-day supply of perishable food. Exterior tour conducted, all exits open and free of obstructions. Side gate was observed to be self-latching. Fire extinguisher located in the dining room was purchased on 4/27/23. Smoke detectors and carbon monoxide detectors (combo alarm) observed operational during today's inspection. Last fire drill conducted on 12/4/2023. All cleaning supplies are locked in secured in locked cabinet in the garage. LPA reviewed staff and client records. Medications reviewed and observed to be well organized in bubble packs with original labels. First Aid Kit contained the required supplies. LPA is requesting the following documents be submitted to the Fresno CCL office by 1/12/2024: 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). Surety Bond.