Facility Evaluation Report

On 10/19/2021, Licensing Program Analyst (LPA) arrived unannounced to conduct an Annual Inspection - Infection Control. LPA introduced self, disclosed the purpose of the visit and met with Licensee, Tynetta Shabazz. Facility has one central entry and exit point.

There are currently no residents residing in the facility and the facility is not staffed.

Facility tour conducted with Licensee. All pathways, entrances and exits were clear from obstructions. No fire clearance issues. Hand-sanitizer is readily available. LPA checked food supply, observed a 7-day supply of non-perishable foods and a 2-day supply of perishable foods. Facility has an adequate supply of cleaning supplies. Facility has a sufficient amount of PPE supplies. Bathrooms are stocked with liquid soap and paper towels. Bedrooms toured. LPA observed the beds to be at least six feet apart and 3 feet apart with head to toe orientation.

LPA is requesting the following documents be submitted to the Fresno CCL office by 11/02/2021: Current copy of Administrator Certificate, Designation of Facility Responsibility (LIC308), Administrator Organization (LIC 309), Affidavit regarding Client/Resident Cash Resources (LIC 400), Emergency and Disaster Plan (LIC610-D) , Personnel Report (LIC500), Register of Facility Clients/Residents for LIC9020.

An exit interview was conducted with Licensee. As a COVID-19 precautionary measure, a copy of this report will be provided via email and an electronic read receipt confirms receiving this document. Report signed on-site by Facility Representative.