Routine inspection·October 6, 2021

An Annual Inspection Control visit was conducted on the date & times indicated above by LPA K. Mcclurg. LPA met with Licensee (L) Davilyn Mancilla. LPA reviewed the purpose of the visit with L. Facility tour conducted. One central entry point has been designated for universal entry screening. Routine symptom screening including temperature taken & recorded daily for all staff, residents, & visitors. Infection Control signs observed to be posted, including in bathrooms with hand washing techniques. Soap & paper towels available. Hand sanitizer available on entry & throughout the facility. Face coverings in use. Infection control policies & procedures & practices in place & currently applied. No deficiencies issued. Exit interview conducted with L. Report Provided Continued. Continued from Page 1. 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 · LIC 500 Personnel Report · LIC 610E Emergency Disaster Plan For Residential Care Facilities For The Elderly · LIC 9020 Register of Facility Clients/Residents (please include Date of Birth & Admission Date) · 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: Sunday, October 31, 2021 As an operator of a Community Care Licensed facility it is your responsibility to be aware of and in compliance with all regulations, including Chaptered Legislation. Go to www.ccld.ca.gov to stay updated and informed.