Facility Evaluation Report

On 9/3/25 Licensing Program Analyst (LPA) J. Leffall arrived unannounced to conduct an Annual Inspection. LPA introduced self, stated the purpose of the visit, and was greeted by Staff (S1) Oscar Aninon. Administrator Camala Kopacz did not attend visit as she is out of the country. LPA was granted entry. 4 residents were present during inspection and the other 2 attended Day Program. Staff (S2) Ann Marie Bushay was present during the visit as well.

LPA toured facility with S2. 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 -0 degrees F and refrigerator temperature was maintained at 38 degrees F. Fire extinguisher was observed with a purchase date of: 5/20/25. Fire drill last completed on 7/11/24. 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 107.2 degrees in bathroom 1 and 1112.8 degrees F. in bathroom 2. Non-skid mat and grab bars observed in bathrooms. 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 hall closet. Residents’ MARS was reviewed. 2 medications were observed to be signed/initialed on the wrong dates. First aide kit observed with all of the required items.

All residents and a sample of staff files reviewed to have all the required documents.

The following deficiency is 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 09/17/25: Lic 308, Lic 500, Lic 610E, Current Liability Insurance and current Administrator’s certificate. A copy of this report was provided to S2, whose signature on this form confirms receipt of these report.