Facility Evaluation Report

On 6/08/2022, Licensing Program Analyst (LPA) K. Kaur arrived unannounced at the above facility to conduct an Annual Inspection- Infection Control. LPA introduced self, stated the purpose of the visit, and was granted entry to the facility by Administrator Inthone Milly.

Visitor log-in/temperature check station was observed upon entry. Hand sanitizer was readily available to residents and visitors. Facility has one entrance/exit point. Hand washing and other various Covid-19 related signs were observed in the common areas. Facility staff was observed with mask covering.

The facility was observed to be at a comfortable temperature, clean, in good repair, and no passageway obstructions or fire hazards were observed. Common areas were properly furnished and well-lit throughout. Chemicals, cleaning supplies, PPE, were observed locked in the basement. Social distancing is maintained in the common and dining areas. A 2-day supply of perishable and 7-day supply of non-perishable food was observed to be properly stored and labelled. Fire extinguisher was observed with a purchase date of: 3/10/2022. Additional food was kept in a refrigerators in the extra closet in the living room. Resident's Bedrooms were observed to be adequately furnished with bed, dresser, and adequate lightning.

LPA is requesting the following documents be submitted to the Fresno CCL office by 6/15/2022: Current copy

of Administrator Certificate, Designation of Facility Responsibility (LIC308), Administrator Organization (LIC309), Affidavit regarding Client/Resident Cash Resources (LIC 400), Emergency and Disaster Plan, Personnel Report (LIC500), Register of Facility Clients/Residents for (LIC9020).

An exit interview was conducted with Administrator. Report signed on-site by Administrator and printed copy provided.