Routine inspection·August 24, 2023

On 08/24/2023, Licensing Program Analyst (LPA) A. Walton arrived at the facility unannounced to conduct an Annual Required Inspection. LPA introduced self, stated the purpose of the visit and was allowed to enter the facility by facility staff. Facility staff contacted Administrator, John Nobleza via telephone. Administrator arrived a short time later. LPA conducted a tour inside and outside of facility. 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 mats were observed. Hot water measured at 118.0 degrees F. 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 serviced on 07/17/2023. Smoke detectors and carbon monoxide detectors observed operational during today’s inspection. Last fire drill conducted 07/2023. All cleaning supplies are locked in a cabinet in the garage. First Aid Kit contained the required supplies. LPA reviewed staff and client records. Upon review, LPA did not observe a needs and services plan for 6 out of 6 residents in care. R3 did not have a restricted health care plan on file. House care plans for 3 out of 3 residents were incomplete. Hospice records were observed to be missing training for assigned staff. Medications reviewed. LPA observed that R1 was receiving an over the counter medication that had not been prescribed by a physician. LPA observed an pre-dosed insulin injection pen to be in the refrigerator accessible to persons other than employees. CONTINUED TO 809C Based on today's inspection, deficiencies were cited in the areas evaluated and listed on the 809-D according to California Code of Regulations, Title 22, Division 6. Exit interview was conducted and a plan of correction was reviewed and developed. A copy of this report and appeal rights were discussed and provided to Administrator, John Nobelza, whose signature on this form confirms receipt of this document LPA is requesting the following documents be submitted to the Fresno CCL office by 09/07/2023 : Current copy of Administrator Certificate, 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.