Facility Evaluation Report
On 01/19/2023, 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 Licensee Betty Prince .
Visitor log-in/temperature check, masks, and disinfection station were observed upon entry. Facility has one entrance/exit point. Hand sanitizer was readily available to residents and visitors. Hand washing and other various Covid-19 related signs were observed in the common areas.
All pathways, entrances and exits were clear from obstructions. Facility staff observed with facial coverings.
LPA toured 2 bedrooms with adequate furnishings. At 11:26 LPA observed the facility to have debris on the floor throughout the facility. LPA toured the facility kitchen. LPA observed a 7-day supply of non-perishable foods and a 2-day supply of perishable foods. Fire extinguisher in hallway was last serviced on 08/1/2022 and was fully charged. LPA observed pool to be behind a locked gate. LPA observed at 12:10 PM Facility grounds in need of cleaning. At 12:22 LPA observed the dinning room window screen to be bent/broken. LPA checked residents' medication and observed a 30-day supply. Staff files were reviewed for good health and COVID Training. LPA observed updated emergency contact information for Resident’s.
Deficiency is being cited on the attached 809D in accordance to California Code of Regulations, Title 22,
LPA is requesting the following documents be submitted to the Fresno CCL office by 1/26/2023: 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, Personnel
Report (LIC500), Register of Facility Clients/Residents for LIC9020. An exit interview was conducted with
Administrator. Report signed on-site; a copy of this report, 809D with appeal rights was provided. .
Source: California Department of Social Services, Community Care Licensing. Methodology · Report a correction