Routine inspection·April 25, 2024

Licensing Program Analyst (LPA) Lissett Padgett arrived unannounced to conduct the Annual inspection. LPA met with caregiver Guadalupe Jimenez (GJ) Administrator, Isai Jimenez (AD) was called and arrived shortly thereafter and explained the purpose of the visit. Facility was toured with GJ. During this visit, LPA toured the facility inside & out. Resident rooms contained required furnishings and lighting. LPA observed required items in the two bathrooms with hot water measuring between 110.3 to 107.2 degrees F. At 10:48am LPA observed what appeared to be dark colored mold on the shower floor, lower tiles and on non skid mat in bedroom 3. At 10:51am LPA observed the sliding glass door in bedroom 3 was shattered on the exterior pane. AD arrived later and explained that the gardener had accidentally shattered it a few days ago. Resident hygiene supplies were properly stored and available. The kitchen was toured observed in good repair with necessary items and appliances and sharps/knives were properly stored. Emergency food supply observed. Medications are centrally stored and locked. Facility has designated visitation areas available inside and out. Doors and passageways are unobstructed throughout the facility including outdoors. First aid kit reviewed and found to contain required items. Fire Extinguisher located in the kitchen was serviced in June 2023. Smoke detectors in hall, kitchen and bedrooms were tested and Carbon Monoxide detector in hallway was tested in found to be operational. LPA conducted resident and staff file reviews and interviews. LPA observed one staff member’s file to be missing health screening form. LPA toured the backyard. At 10:58am LPA observed chicken feces on the patio chairs. Licensee has pet chickens/roosters. Deficiencies are being cited in accordance with California Code of Regulations on the attached LIC 809-D. An exit interview was conducted and a Plan of Correction was developed. A copy of this report and Appeal Rights were discussed and emailed to AD, whose signature on this form confirms receipt of these documents. LPA is requesting the following documents be submitted to the Fresno CCL office by 5/3/2024: 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 610D) Personnel Report (LIC500), Register of Facility Clients/Residents for (LIC9020A), Surety Bond .