Routine inspection·May 21, 2025

Licensing Program Analyst (LPA) Rachel Bruce arrived unannounced to conduct the Annual inspection. LPA met with caregiver Guadalupe Jimenez (CG) and Raquel Jimenez, Administrator Assistant (ADA) and Caregiver. LPA toured facility with CG and ADA. All four residents were present at the time of visit, none are currently enrolled in day programs. One resident had family visitors at the time of the inspection who expressed they were pleased with the level of care that their husband/father was receiving. During this inspection of the facility, the following was noted: Resident rooms were clean and contained required furnishings and lighting. Window screens were present in every bedroom and were in good repair. LPA observed required items in the two bathrooms with hot water measuring within regulatory requirements. The resident bathroom had the following issues- Bathtub faucet was leaking, water stain/mold at bathtub faucet area, wooden board covering the bottom of bathroom sink needs to be replaced, hole in wall behind toilet, and handle missing on cabinet under sink. Hallway closets store linen and adequate supply noted. Resident hygiene supplies were properly stored and available. The kitchen was toured and observed in good repair. Sharps/knives were properly locked and stored in a kitchen cabinet. Emergency food and water supply stored in hallway closet along with overflow of non-perishable food items. LPA noted 2 days of perishable food and 7 days of non- perishable food. Menu posted on refrigerator and alternative menu items available. There are no residents with special dietary needs at this time. Medications are centrally stored and locked in hallway closet. Medication dispensing records stored and locked with employee and resident files. First aid kit contains required items and is located in hallway closet with medication. Facility has designated visitation areas available inside and out. Doors and passageways are unobstructed throughout the facility including outdoors. Outside physical plant issues include the following: Chicken coop to be removed, and warped and weathered facing boards at the front of the house are in need of replacement. Fire Extinguisher located in the kitchen was serviced in February 2024 and is need of reinspection. Smoke detectors in hall, kitchen and bedrooms were tested and Carbon Monoxide detector in hallway were tested -all were found to be operational. LPA reviewed 4 resident files and 4 staff files. Items were missing from both- see attached deficiency page for documentation of violation. 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 left with ADA , whose signature on this form confirms receipt of these documents. LPA is requesting the following documents be submitted to the Fresno CCL office by 6/10/2025: Current copy of Administrator Certificate, Designation of Facility Responsibility (LIC308), Administrator Organization (LIC 309), Liability Insurance, Emergency and Disaster Plan (LIC 610D) Personnel Report (LIC500), Register of Facility Clients/Residents for (LIC9020A), Surety Bond