Routine inspection·October 23, 2024

On 10/23/2024, Licensing Program Analyst (LPA) Walton arrived unannounced to conduct an annual inspection. LPA introduced self, stated the purpose of the visit and requested to meet with the Administrator. LPA was granted entry to the facility and began the inspection with Assistant Administrator, Amy Rawlins. Administrator, Merilyn Bergstrom, arrived a short time later. LPA reviewed facility records. Upon review of records, LPA found that S1 had not been cleared prior to working in the facility. LPA contacted CCLD staff and confirmed that S1 has not been cleared to work in the facility. LPA reviewed resident files, including hospice records, and found the records to be current and complete. LPA reviewed personnel records of cleared staff and found the records to be current and complete. LPA reviewed the facility emergency disaster plan. Facility records indicate the last fire drill was conducted on 10/19/2024. LPA conducted a tour of the facility. Facility appeared clean, odor free, and at a comfortable temperature. Common areas and the dining area had adequate seating and lighting available. Kitchen was toured and observed to be safe for food preparation. LPA observed an adequate food supply. Resident bedrooms were observed to have required furnishings. Bathrooms were toured and observed to be operational. LPA observed securely fastened grab bars and trash cans equipped with lids. Hot water measured at 114.4. Smoke detector and carbon monoxide detector observed to be operational during today's inspection. Exterior tour conducted. All passageways were open and free from obstructions. Side gate was observed to be self-latching. Medications reviewed and observed to be administered as prescribed. A deficiency is being issued in accordance to California Code of Regulations, Title 22, Division 6 on the attached 809D. A civil penalty is being assessed in the amount of $100, for background clearance. Exit interview conducted and a plan of correction was reviewed and developed with Administrator. A copy of this report and appeal rights were discussed and provided to Assistant Administrator, whose signature on this form confirms receipt of this document. LPA is requesting the following documents be submitted to the Fresno CCL office by 11/06/2024: 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 610E), Personnel Report (LIC500), Register of Facility Clients/Residents for (LIC9020A), Surety Bond