Routine inspection·June 6, 2023

On 06/06/23, Licensing Program Analyst (LPA) M. Yang arrived unannounced to conduct an Annual Inspection. LPA was greeted by Licensee (L1) Marguerite and was granted entry into the facility. LPA introduced self and stated the purpose of the visit. LPA conducted tour with L1. All six residents were present during inspection. The tour started in the common areas, into kitchen to resident's rooms. The facility was observed to be at a comfortable temperature, clean, in good repair, and no passageway obstructions or fire hazards were observed inside. Fire extinguisher was observed with purchased date 04/10/22. At approximately 12:06AM, LPA and L1 observed one resident medication cup fill for AM and one resident medication cup for noon both fill with medications on kitchen counter unlock. LPA reviewed residents’ MARS. First aid kit was observed and contained all required items. An adequate supply of perishable and non-perishable food was observed. Refrigerator maintained at a 58 degrees F. Residents' bedrooms were toured and observed to be adequately furnished with bed, dresser, and adequate lighting. LPA observed 2 shared residents’ bed to be at least 6 feet apart and 2 single occupant bedrooms. Bathrooms were properly equipped. Hot water temperature 115.4 to in bathroom 1 and ranged between 116.1 degrees F to 116.4 degrees F in bathroom in the shared bedroom. Cleaning supplies and chemicals are kept in locked in laundry room. Outside of facility toured. Outside seating was observed available for residents. Side gate was self-closing and self-latching. Carbon monoxide and smoke detectors were tested and observed to be operational. A sample of residents’ file reviewed to have update Emergency contacts, Admission agreement, Pre-Appraisal form, and physician report. A sample of staff's files were also reviewed to have current First Aid/CPR, Personnel Record, Health Screening, and associated with facility. A deficiency is being cited on the attached 809D in accordance to California Code of Regulations, Title 22, Division 6. An exit Interview conducted. The following documents are requested and submitted to Fresno CCL by: 06/13/23. The following updated forms were requested: Lic 308, Lic 500, Lic 610E, current liability insurance, control of property, and current Administrator. A copy of this report and appeal rights was provided to Licensee, whose signature on this form confirms receipt of this report.