Facility Evaluation Report

On 07/16/26 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) Elizabeth Vassell. LPAs was granted entry. 3 clients were present during inspection and then departed for Day Program. Administrator (A1) Camalah Kopacz arrived shortly after LPA’s arrival.

LPAs toured facility with A1. 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 39 degrees F. Cleaning chemicals was observed stored and locked under kitchen sink. Fire extinguisher was observed with a service date of: 6/3/26. Fire drill last completed on 05/4/26. Clients' 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 tested at a range of 107.2 to 109 degrees F in 3 bathrooms. Outside of facility toured. Side gates were self-closing and self-latching. Outside was observed with adequate outdoor seatings available for clients. Medications were checked and observed kept locked in medication cart. Clients’ MARS was reviewed.

Carbon monoxide and smoke detectors were tested and observed to be operational. All clients’ file reviewed to have all the required documents. A sample of staff files and all clients’ files were reviewed and observed to have all the required documents.

Exit Interview conducted. LPA is requesting the following documents be submitted to the Fresno CCL office by 7/30/26: Current copy of Administrator Certificate, Designation of Facility Responsibility (LIC308), Administrator Organization (LIC 309), Affidavit regarding Client/Resident Cash Resources (LIC 400), Liability Insurance-RCFE, Emergency and Disaster Plan (LIC 610E), Personnel Report (LIC500), Register of Facility Clients/Residents for (LIC9020A)

A copy of this report was provided to Administrator, whose signature on this form confirms receipt of this report.