Facility Evaluation Report

On 10/07/2021, Licensing Program Analyst (LPA) M. Yang arrived unannounced at the above facility to conduct an Annual Inspection- Infection Control. LPA introduced self, stated the purpose of the visit and requested to meet with the Administrator. LPA met with Alicia Paloma, caregiver. Upon entry staff was observed not wearing facial covering. LPA toured facility with caregiver. Akwant Malhi, Administrator arrived in a short time later and conduct tour with LPA. Six residents were present during the tour.

Visitor log-in was observed upon entry. Facility has one entrance/exit point. Facility appeared cleaned with no obstruction or fire clearance issues. LPA observed opened Ajax cleaning bottle under unlocked kitchen sink. Hand sanitizer was readily available to residents and visitors. Social distancing is maintained in the common and dining areas. LPA did not observe cough etiquette signs and social distancing. LPA observed bathrooms did not have trash cans with lid. LPA observed no hand washing signs at bathroom sinks. LPA observed in 2 shared bedrooms residents’ bed to be at least 3 feet apart with head to toe orientation. LPA toured 2 single occupant resident bedrooms furnished and lit. LPA checked residents’ locked medications . LPA did not observed a 30-day PPE supplies. Food supplies was checked and there appeared to be an adequate supply. Fire extinguisher observed to be serviced:05/03/21. A sample of residents’ record reviewed: 1 out of 6 have updated emergency contact information.

A deficiency is being cited on the attached Lic 809D in accordance to California Code of Regulations, Title 22, Division 6.

Exit interview was conducted. A plan of correction was developed and reviewed with the administrator. Requested forms/ information: Lic 308, Lic 500, Lic 610D, Lic 9020, and current Administrator Certification. Please submit the above forms/information to Fresno CCL by: 10/13/21. Administrator was informed that as a COVID-19 precautionary measure, this report and appeal rights will be provided via email and an electronic read