Routine inspection·April 2, 2025

On 04/02/25, Licensing Program Analyst (LPA) M. Yang arrived unannounced to conduct an Annual Inspection. LPA introduced self, stated the purpose of the visit, and met with Administrator(A1) Petro Crisostomo. Upon arrival audio video camera monitor observed in the common area. LPA toured facility with A1. All five residents were present during the inspection. Three residents were observed sitting in the living room and two in the bedrooms. The facility was observed to be at a comfortable temperature, clean, in good repair, and no passageway obstructions or fire hazards were observed inside. All residents’ files were reviewed to have required documents. Medications were checked and observed unlocked medication cart and kitchen shelf. Residents’ MARS and Centrally Stored Medication Records were reviewed. Fire extinguisher was observed with a service date of:03/03/25. Last fire drill completed on 01/10/25. An adequate supply of perishable and non-perishable food was observed. Freezer temperature maintained at 0 degree F and refrigerator temperature maintained at 44 degrees F. Knives observed locked in kitchen drawer . LPA observed over-the-counter medications stored in First Aid box unlock on the kitchen wall. Washer and dryer observed functional and operational during visit. Residents' bedrooms were toured and observed to be adequately furnished with bed, dresser, and adequate lighting. All bathrooms are observed with securely fastened grab bars and non-skid mat. Hot water temperature was tested range at 118.9 and 117.7 degrees F in master bathroom and 118.9 degrees F in hall bathroom. Outside of facility toured and observed free of debris. Side exit observed with no obstructions. Carbon monoxide and smoke detectors were tested and observed to be operational. A sample of staff files were reviewed to have all required documents. Carbon monoxide and smoke detector operational during visit. Technical Support Program (TSP) assistance was offered to Administrator. Administrator will make a decision and reach out the department regarding acceptance. A deficiency is being cited, per California Code of Regulations, Title 22, Division 6, see attached Lic 809D. A civil penalty is being assessed see attached Lic 421IM. Exit Interview conducted. The following documents are requested and submitted to Fresno CCL by: 04/08/25. The following updated forms were requested: Lic 308, Lic 500, Lic 610E, current Administrator Certificate, and current liability insurance. A copy of this report and appeal rights was provided to Administrator, whose signature on this form confirms receipt of this report.