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, and PPE were observed in garage. 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. Resident's Bedrooms were observed to be adequately furnished with bed, dresser, and adequate lighting.

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.