Routine inspection·October 11, 2021

Licensing Program Analyst (LPA) Lady Cabrera arrived unannounced for an Annual Required Inspection. Administrator Estrellito Magliba was unavailable, however, designated Erlinda Magliba. LPA was met by Designated Representative Erlinda Magliba and stated the purpose of the visit. A tour of the facility was conducted. COVID-19 guidelines are in place. Visitor log-in/temperature check was observed upon entry. Facility has one entrance/exit point. Facility appeared cleaned with no obstruction or fire clearance issues. Hand sanitizer was readily available to residents and visitors. Social distancing is maintained in the common and dining areas. Bathrooms have trashcans. Hand washing posters were observed by the bathroom sinks. Bedrooms were checked and beds are six feet apart. The exterior tour was conducted. LPA checked residents’ medications and observed a 30-day supply. Food supply was checked and there appeared to be an adequate supply. Cleaning and PPE supplies were checked. Facility staff was observed with mask on. Residents wear masks when away from the community. Resident’s files have updated emergency contact information. LPA followed up on an incident reported that occurred on 07/13/2021 regarding Resident (R1) being hit by a branch and getting stuck. Deficiencies are being cited on the attached LIC 809 -D. Community Care Licensing (CCL) is always striving to have facility files that reflect the most accurate & up to date information for your facility. In an effort to maintain your facility file, please submit the most current & complete forms &/or information as identified below: Residential Care Facility for the Elderly (RCFE):  LIC 308 Designation of Facility Responsibility  -as applicable: LIC 309 Administrative Organization  -as applicable: LIC 400 Affidavit Regarding Client/Resident Cash Resources  -as applicable: LIC 402 Surety Bond  LIC 500 Personnel Report  LIC 610E Emergency Disaster Plan For Residential Care Facilities For The Elderly  LIC 9020 Register of Facility Clients/Residents  Copy of current Liability Insurance  Copy of current Administrator Certificate  Alternate contact information including name, telephone number, & email address. Please submit the above forms/information to Fresno CCL by: 10/15/2021 by 12p.m. Exit interview was conducted. A copy of this report, LIC809, LIC809-D and appeal rights were provided. The Licensee’s signature on this form acknowledges receipt of these documents.