Routine inspection·November 23, 2021

On 11/23/21, Licensing Program Analyst (LPA) M. Yang arrived unannounced to conduct an Annual Inspection - Infection Control. LPA introduced self, stated the purpose of the visit and met with Administrator Alexis Bell. LPA conduct tour with Administrator. All six residents were present during the inspection. Facility staff was observed with mask on. Visitor log-in/temperature check was observed upon entry. Hand sanitizer was readily available to residents and visitors. Social distancing is maintained in the common and dining areas. Social distancing and cough etiquette postings observed in facility. Facility has one entrance/exit point. Facility appeared cleaned with no obstruction or fire clearance issues. LPA checked residents’ locked medications. 30-day PPE supplies were observed. LPA observed cleaning chemicals in laundry room unlocked. Food supply was checked and appeared to be an adequate suppl y. LPA observed fire extinguisher not serviced: 02/13/21. LPA observed a bleach in facility office unlocked. LPA toured bathroom. Trash bin in bathrooms was observed with n o lid. Securely fastened grab bars observed in bathroom. H and washing sign observed in bathroom sinks. All resident’s room toured and observed to be adequately furnished and lit. LPA observed 3 shared resident’s bedrooms to be at least 6 feet apart. The exterior tour was conducted. Staff records were reviewed for good health and infection control training. Four out of six residents’ records reviewed to have updated emergency contact information. A deficiency is being cited on the attached 809D in accordance to California Code of Regulations, Title 22, Division 6. Exit interview was conducted. A plan of correction was developed and reviewed with the administrator. The following documents are requested and submitted to Fresno CCL by: 12/3/21. The following updated forms were requested: Control of property(lease), Lic 308, Lic 309, Lic 400, Lic 402, Lic 500, Lic 610D, and Lic 9020. LPA received copy of Administrator certificate during facility inspection. Administrator was informed that as COVID-19 precautionary measure, this report will be provided via email. Report signed on-site.