Routine inspection·February 26, 2025

On 2/26/24, Licensing Program Analyst (LPA) R. Bruce conducted a required unannounced Annual Inspection visit. LPA introduced self, stated purpose of visit, was allowed entrance and met with Sister Acacia. LPA toured the facility inside and out to include entry, kitchen, dining, bedrooms, bathrooms, and exterior. All fire exit routes were free and clear of obstructions. LPA observed the facility to be clean free from clutter, and odor free. Medications are stored in a locked cabinet in individual wings. LPA observed knifes and cleaning supplies are locked and stored appropriately. Other storage spaces containing toxins & cleaning supplies were locked. LPA checked the water temperature in a common bathroom in A and B wing which read at 105.9 and 105.2. Water temperature in the kitchen was at 125.2 degrees Fahrenheit and had appropriate signage to warn of hot water temperature. Facility has license for capacity of 76, and current census is 42. Resident’s do not share bedrooms, and each bedroom has their own bathroom. Five resident and five staff files were reviewed and found to contain all required documentation. Fire extinguishers are located throughout the facility and were last serviced on 12/23/2024 by Jorgenson Fire, and are in good standing. LPA reviewed Fire and Disaster plan noting fire drills are held monthly and meet regulatory requirements. Smoke alarms are tested periodically throughout the year. No deficiencies were issued at today's inspection visit. EXit interview was conducted and a copy of this report LIC809, was provided to facility. LPA requested the following documents to be submitted to CCL via fax line at 559-243-8088: LIC 500 Personnel Report, LIC 308 Designation of Administrative Responsibility, LIC 610-E the Emergency Disaster Plan and copy of current Administrator’s Certificate to update the facility file. Listed documents shall be sent to Licensing by March 15, 2025.