Routine inspection·June 2, 2023

On 6/2/2023, Licensing Program Analyst (LPA) K. Kaur arrived unannounced at the above facility to conduct an Annual Inspection. LPA introduced self, stated the purpose of the visit, and was granted entry to the facility by staff Raquel Jimenez. Licensee/Administrator was not available for inspection. The facility was observed to be at a comfortable temperature, clean, in good repair, and no passageway obstructions were observed inside or outside. Common areas were properly furnished and well-lit throughout. There are 3 residents on hospice at this time. The dining room is equipped with a table and chairs, living room is equipped with adequate sofas and recliners for six residents, adequate outside space for rest and recreational. Backyard gate is self-closing and self-latching. 7-day supply of non-perishable foods and a 2-day supply of perishable foods observed. Knives are locked in the kitchen cabinet. Cleaning and Chemical supplies are kept in locked cabinet under the kitchen sink and garage. At 12:19 PM LPA observed Fire extinguisher in kitchen to be expired with a service date of 3/4/2022. LPA observed a Residents' bedrooms were observed to be adequately furnished with bed, dresser, and adequate lighting. Mattresses and linen were in good condition. Extra linen and towels are available. Hot water temperature measured at 122.4 degrees F. Carbon monoxide and smoke alarm detectors installed and operational. Grab bars installed in showers and by toilets, non-skid mats in place. At 1:10 PM LPA observed one staff member’s file to be missing health screening form. Staff also stated she had not completed a Health screening. Resident's records contained Personal Rights, and current Physician's Report. Resident’s files have updated emergency contact information. Staff files were reviewed for good health. It was verified that there are at least one staff on duty who is CPR certified. Deficiency is being cited on the attached 809D in accordance to California Code of Regulations, Title 22, Division 6.Continued on LIC809C... LPA is requesting the following documents be submitted to the Fresno CCL office by 6/28/2022: Current copy of Administrator Certificate, Designation of Facility Responsibility (LIC308), Administrator Organization (LIC309), Affidavit regarding Client/Resident Cash Resources (LIC 400), Emergency and Disaster Plan (LIC610E), Personnel Report (LIC500), Register of Facility Clients/Residents for LIC9020. An exit interview was conducted with staff. Report signed on-site and printed copy provided with appeal rights.