Facility Evaluation Report

On 04/17/26, Licensing Program Analyst (LPA) M. Yang arrived unannounced to conduct an Annual Inspection. LPA introduced self, stated the purpose of the visit, and met with staff Tiffany Owen. Licensee Paulette Holland was called and arrived shortly during visit. LPA toured facility with Licensee. All five residents were present during the inspection in the living room.

The facility was observed to be at a comfortable temperature, clean, in good repair, and no passageway obstructions or fire hazards were observed inside. Video cameras with audio observed in the living room and kitchen. All residents’ files were reviewed.Fire extinguisher was observed with a service date of: 12/09/25. An adequate supply of perishable and non-perishable food was observed. Freezer temperature was maintained at -2 degree F and refrigerator temperature maintained at 37 degrees F. Knives observed locked in kitchen drawer. First Aid supplies lock medication cabinet. Residents' bedrooms were toured and observed to be adequately furnished with bed, dresser, and adequate lighting. All bathrooms are observed with securely fastened grab bars and non-skid mats. Hot water temperature was tested at 110.8 in bathroom 1 and 110.6 degrees F in bathroom 2. Outside of facility toured and observed free of obstruction. Outdoor seatings observed available for the residents. Medications were checked and observed locked medication cabinet in the dining area. MARS and Centrally Stored Medication Records was reviewed. Carbon monoxide and smoke detectors were tested and observed to be operational. A sample of staff files were reviewed.

Technical Support Program (TSP) assistance was offered. Licensee will make a decision and reach out the department regarding acceptance.

A deficiency is being cited on the attached Lic 809D in accordance to California Code of Regulations, Title 22, Division 6 see attached 809D. Exit Interview conducted. The following documents are requested and submitted to Fresno CCL by: 04/23/26. The following updated forms were requested: Lic 308, Lic 500, Lic 610E, current Administrator Certificate, and current liability insurance. A copy of this report was provided to Licensee, whose signature on this form confirms receipt of this report.