Facility Evaluation Report

On 10/29/24 at 8:30am Licensing Program Analyst (LPA) J. Leffall arrived unannounced to conduct an Annual Inspection LPA was greeted by Ansar Timmons (S1). LPA introduced self, stated the purpose of the visit Licensee (L1) Linda Burrus was present during inspection. LPA was granted entry. No residents were present during inspection because of attendance at day program.

LPA toured facility with L1. The facility was observed to be at a comfortable temperature, clean, in good repair, and no passageway obstructions or fire hazards were observed inside. An adequate supply of perishable and non-perishable food was observed. Freezer temperature was maintained at -5 degrees F and refrigerator temperature was maintained at 35 degrees F. Fire extinguisher was observed with a purchase date of: 12/5/23. Fire drill last completed on 10/15/24. Washer and dryer observed operational during visit. Carbon monoxide and smoke detectors were tested and observed to be operational. Residents' bedrooms were toured and observed to be adequately furnished with bed, dresser, and adequate lighting. All bathrooms are toured and observed to be operational. Hot water temperature was tested at a temperature of 116 degrees in bathroom 1 and 110 degrees F. in bathroom 2. Outside of facility toured. Side gate was self-closing and self-latching. Outside was observed with adequate outdoor seatings available for residents. A sample of medications were checked and observed kept locked in the locked cabinet. Residents’ MARS was reviewed. A sample of medications were checked and observed kept locked in cabinet. First aide kit observed with all of the required items.

All residents and samples of staff files reviewed to have most required documents. Upon review (S1) does not have LIC-503 on file. Upon further review LIC-602 not obtained for 1 out of 1 resident (R1)

Deficiencies are being cited on the attached 809D in accordance with California Code of Regulations, Title 22,Division 6.

Exit Interview conducted. The following documents requested to be updated and submitted to Fresno CCL by 11/13/24: Lic 308, Lic 500, Lic 610E, Current Liability Insurance and current Administrator’s certificate. A copy of this report and Appeal Rights were provided to Licensee, whose signature on this form confirms receipt of these reports.